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Shapiro GK, Santiago AT, Pittman T, Iwano K, Rodin G, Cole H, Zeman K, Sellmann S, Oza AM, Jones J, Rosenthal M, Conti RM, Rodin D. Disparities in clinical trial enrollment at a Canadian comprehensive cancer center: A 15-year retrospective study. Cancer 2024; 130:2782-2794. [PMID: 38662430 DOI: 10.1002/cncr.35331] [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: 12/01/2023] [Revised: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Disparities in clinical trials (CTs) enrollment perpetuate inequities in treatment access and outcomes, but there is a paucity of Canadian data. The objective of this study was to examine disparities in cancer CT enrollment at a large Canadian comprehensive cancer center. METHODS Retrospective study of CT enrollment among new patient consultations from 2006 to 2019, with follow-up to 2021 (N = 154,880), with the primary outcome of enrollment as a binary variable. Factors associated with CT enrollment were evaluated using multivariable Bayesian hierarchical logistic regression with random effects for most responsible physician (MRP) and geography, adjusted for patient characteristics (sex, age, language, geography, and primary care provider [PCP]), area-level marginalization (residential instability, material deprivation, dependency, and ethnic concentration), disease (cancer site and stage), and MRP (department, sex, language, and training). A sensitivity analysis of the cumulative incidence of enrollment was conducted to account for differences in disease type and follow-up length. RESULTS CT enrollment was 11.2% overall, with a 15-year cumulative incidence of 18%. Lower odds of enrollment were observed in patients who were female (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.78-0.86), ≥65 years (AOR vs. <40, 0.61; 95% CI, 0.56-0.66), non-English speakers (0.72; 95% CI, 0.67-0.77), living ≥250 km away (AOR vs. <15 km, 0.71; 95% CI, 0.62-0.80), and without a PCP. Disease characteristics accounted for the largest proportion of observed variation (20.8%), with significantly greater odds of enrollment in patients with genitourinary cancers and late-stage disease. CONCLUSION Significant sociodemographic disparities were observed, suggesting the need for targeted strategies to increase diversity in access to cancer CTs in Canada.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anna T Santiago
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tyler Pittman
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kai Iwano
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Heather Cole
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Katherine Zeman
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Susanna Sellmann
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rena M Conti
- Department of Markets, Public Policy, and Law, Boston University Questrom School of Business, Boston, Massachusetts, USA
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Understanding and tackling cancer inequities: What opportunities does intersectionality offer researchers, policymakers, and providers? A scoping review. J Psychosoc Oncol 2024:1-28. [PMID: 39120128 DOI: 10.1080/07347332.2024.2361642] [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: 08/10/2024]
Abstract
PROBLEM IDENTIFICATION We summarised the international evidence relating to the role of intersectionality in patients' lived experience of inequities along the cancer care pathway. We produced guidance to use intersectionality in future research. LITERATURE SEARCH We included 42 articles published between 1989 to 2023 that used intersectionality to guide the study and interpretation of inequities in cancer care. DATA EVALUATION/SYNTHESIS Articles predominantly comprised North American (n = 37), followed by European (n = 4) and Asian (n = 1) studies. Similar compounding effects of racism, homophobia, and discrimination across countries exacerbated inequities in cancer care experience and cancer outcomes particularly for women of color and sexual/gender minority groups. Professionals' knowledge, attitudes, and behaviors toward minoritised groups affected patient-provider relationships and influenced cancer patients' psychosocial responses. CONCLUSION Intersectionality provides a framework to assess the personal, interpersonal, and structural processes through which cancer inequities manifest within and across countries.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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Scott AJ, Kennedy EB, Berlin J, Brown G, Chalabi M, Cho MT, Cusnir M, Dorth J, George M, Kachnic LA, Kennecke HF, Loree JM, Morris VK, Perez RO, Smith JJ, Strickland MR, Gholami S. Management of Locally Advanced Rectal Cancer: ASCO Guideline. J Clin Oncol 2024:JCO2401160. [PMID: 39116386 DOI: 10.1200/jco.24.01160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE To provide evidence-based guidance for clinicians who treat patients with locally advanced rectal cancer. METHODS A systematic review of the literature published from 2013 to 2023 was conducted to identify relevant systematic reviews, phase II and III randomized controlled trials (RCTs), and observational studies where applicable. RESULTS Twelve RCTs, two systematic reviews, and one nonrandomized study met the inclusion criteria for this systematic review. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RECOMMENDATIONS Following assessment with magnetic resonance imaging, for patients with microsatellite stable or proficient mismatch repair locally advanced rectal cancer, total neoadjuvant therapy (TNT; ie chemoradiation [CRT] and chemotherapy) should be offered as initial treatment for patients with tumors located in the lower rectum and/or patients who are at higher risk for local and/or distant metastases. Patients without higher-risk factors may discuss chemotherapy with selective CRT depending on extent of response, TNT, or neoadjuvant long-course CRT or short-course radiation. For patients who are candidates for TNT, the preferred timing for chemotherapy is after radiation, and neoadjuvant long-course CRT is preferred over short-course radiation therapy (RT), however short-course RT may also be a viable treatment option depending on circumstances. Nonoperative management may be discussed as an alternative to total mesorectal excision for patients who have a clinical complete response to neoadjuvant therapy. For patients whose tumors are microsatellite instability-high or mismatch repair deficient, immunotherapy is recommended.Additional information is available at http://www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | - Gina Brown
- Imperial College London, London, United Kingdom
| | - Myriam Chalabi
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - May T Cho
- University of California Irvine Health, Irvine, CA
| | - Mike Cusnir
- Mount Sinai Comprehensive Cancer Center, Miami Beach, FL
| | | | - Manju George
- Paltown Development Foundation/COLONTOWN, Crownsville, MD
| | - Lisa A Kachnic
- Columbia University, Herbert Irving Comprehensive Cancer Center, New York, NY
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Abioye O, Kiel L, Kaufman R, Florez N. Cancer health disparities in minority communities: peer support networks can bridge the gap. Cancer Causes Control 2024:10.1007/s10552-024-01903-2. [PMID: 39117791 DOI: 10.1007/s10552-024-01903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE Peer support networks have been suggested to have significant utility in the care of patients with cancer, especially among racial minorities. This article proposes an approach to integrate peer support networks into the care of racial minorities with cancer. METHODS Methods to integrate peer support groups across racial minorities with cancer include utilizing language and religion in strategic recruitment of peer supporters, recruiting minority peer supporters in online oncology peer support groups, and emphasizing relationship & trust building for participant retention. RESULTS Language concordance among peer support groups may enhance patient understandability, emotional expression, and create a sense of community and safety. Religious integration may also promote support group accessibility, particularly among Blacks, who tend to depend on their religious communities for cancer care guidance to a greater extent. In addition to providing knowledge, online opportunities may also decrease cancer-related stress, depression, and trauma. Trust between individuals and their sociocultural environment and healthcare system, as well as between the community and the healthcare system, is necessary, particularly for racial minorities who may harbor a historical mistrust of the healthcare system. CONCLUSIONS To close the racial cancer care gap, a multi-pronged approach is crucial. This includes establishing tailored peer support networks within minority communities that account for language, religion, and cultural factors to build trust and meet psycho-social needs. However, peer support is just one tool. Other critical tools such as holding healthcare institutions accountable for providing equitable care to racial minorities is equally vital in reducing disparities and improving survival outcomes.
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Affiliation(s)
| | - Lauren Kiel
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Cancer Care Equity Program, Dana-Farber Cancer Institute Member of the Faculty, Harvard Medical School, 150 Brookline Ave, Dana 1230P, Boston, MA, 02215, USA.
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Boele F, Rosenlund L, Nordentoft S, Melhuish S, Nicklin E, Rydén I, Williamson A, Donders-Kamphuis M, Preusser M, Le Rhun E, Kiesel B, Minniti G, Furtner J, Dirven L, Taphoorn M, Galldiks N, Rudà R, Chalmers A, Short SC, Piil K. Inequalities in access to neuro-oncology supportive care and rehabilitation: A survey of healthcare professionals' perspectives. Neurooncol Pract 2024; 11:484-493. [PMID: 39006521 PMCID: PMC11241368 DOI: 10.1093/nop/npae023] [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] [Indexed: 07/16/2024] Open
Abstract
Background Neuro-oncology patients and caregivers should have equitable access to rehabilitation, supportive-, and palliative care. To investigate existing issues and potential solutions, we surveyed neuro-oncology professionals to explore current barriers and facilitators to screening patients' needs and referral to services. Methods Members of the European Association of Neuro-Oncology and the European Organisation for Research and Treatment of Cancer Brain Tumor Group (EORTC-BTG) were invited to complete a 39-item online questionnaire covering the availability of services, screening, and referral practice. Responses were analyzed descriptively; associations between sociodemographic/clinical variables and screening/referral practice were explored. Results In total, 103 participants completed the survey (67% women and 57% medical doctors). Fifteen professions from 23 countries were represented. Various rehabilitation, supportive-, and palliative care services were available yet rated "inadequate" by 21-37% of participants. Most respondents with a clinical role (n = 94) declare to screen (78%) and to refer (83%) their patients routinely for physical/cognitive/emotional issues. Survey completers (n = 103) indicated the main reasons for not screening/referring were (1) lack of suitable referral options (50%); (2) shortage of healthcare professionals (48%); and (3) long waiting lists (42%). To improve service provision, respondents suggested there is a need for education about neuro-oncology-specific issues (75%), improving the availability of services (65%) and staff (64%), developing international guidelines (64%), and strengthening the existing evidence-base for rehabilitation (60%). Conclusions Detecting and managing neuro-oncology patients' and caregivers' rehabilitation, supportive,- and palliative care needs can be improved. Better international collaboration can help address healthcare disparities.
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Affiliation(s)
- Florien Boele
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Lena Rosenlund
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden
| | - Sara Nordentoft
- Department of Neurosurgery, Neurocentre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sara Melhuish
- Speech and Language Therapy Department, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Emma Nicklin
- Leeds Institute of Medical Research, St James’s Hospital, University of Leeds, Leeds, UK
| | - Isabelle Rydén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Marike Donders-Kamphuis
- Department of Neurosurgery, Haaglanden Medisch Centrum, The Hague, The Netherlands
- Department of Neurosurgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University, Vienna, Austria
| | - Emilie Le Rhun
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Barbara Kiesel
- Department of Neurosurgery, Medical UniversityVienna, Austria
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology & Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Julia Furtner
- Faculty of Medicine and Dentistry, Research Center for Medical Image Analysis and Artificial Intelligence (MIAAI), Danube Private University, Krems, Austria
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Norbert Galldiks
- Department of Radiological Sciences, Oncology and Anatomical Pathology & Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Susan C Short
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karin Piil
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
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Olateju OA, Zeng Z, Zakeri M, Sansgiry SS. Patterns of immunotherapy utilization for non-small cell lung cancer in Texas pre- and post-regulatory approval. Clin Transl Oncol 2024; 26:1908-1920. [PMID: 38554190 DOI: 10.1007/s12094-024-03412-9] [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: 12/29/2023] [Accepted: 02/16/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE Immunotherapy has shown remarkable benefits for non-small cell lung cancer (NSCLC) since approved by the US Food and Drug Administration (FDA). Texas, however, ranks below the national average in access to treatment for NSCLC. This retrospective cohort study assessed first-line immunotherapy treatment patterns and associated factors pre- and post-FDA approval in Texas. METHODS Patients ≥18 years diagnosed with NSCLC from the Texas Cancer Registry database (2011-2018) and were stratified into pre- and post-FDA approval era. The rates of immunotherapy utilization were examined, and the average annual percent change (AAPC) in immunotherapy utilization across patient subgroups was compared. Multivariable logistic regression was used to identify associations of patient characteristics with immunotherapy utilization for patients with metastatic- and all-stage NSCLC. RESULTS A total of 13,501 and 9509 patients with NSCLC were identified in pre-post-approval periods, respectively. Post-approval, immunotherapy utilization increased from 1.7 to 13.0%, and AAPC from 54.8 to 82.7%. Pre-approval, patients living in a county with ≥20% of households below the poverty level were less likely to receive immunotherapy (OR = 0.73, 95% CI = 0.61-0.94) while patients with private insurance were more likely to receive immunotherapy (OR = 1.56, 95% CI = 1.10-2.23). Post-approval, socioeconomic disparities were more prominent (10-19.9 and ≥20% of households below the poverty level: OR = 0.77, 95% CI = 0.66-0.90 and OR = 0.71, 95% CI = 0.60-0.86, respectively). Patients with metastatic NSCLC showed similar patterns of socioeconomic disparities pre- and post-approval. CONCLUSIONS Our findings suggest that patients' socioeconomic status hinders immunotherapy utilization for NSCLC in Texas. This emphasizes the need for state health policy reforms such as Medicaid expansion and tailored cancer care strategies.
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Affiliation(s)
- Olajumoke Adenike Olateju
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Health 2, Room 4050, 4349 Martin Luther King Boulevard, Houston, TX, 77204-5047, USA
| | - Zhen Zeng
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Health 2, Room 4050, 4349 Martin Luther King Boulevard, Houston, TX, 77204-5047, USA
| | - Marjan Zakeri
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Health 2, Room 4050, 4349 Martin Luther King Boulevard, Houston, TX, 77204-5047, USA
| | - Sujit S Sansgiry
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Health 2, Room 4050, 4349 Martin Luther King Boulevard, Houston, TX, 77204-5047, USA.
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Dettwiller P, Ghiya S, McLean J, O'Callaghan S, Sanni A, Shaunak N, So L, Williamson S, Nabhani-Gebara S. Equity, diversity, and inclusion in oncology pharmacy practice: Everyone's business. J Oncol Pharm Pract 2024:10781552241264717. [PMID: 39042935 DOI: 10.1177/10781552241264717] [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: 07/25/2024]
Abstract
INTRODUCTION Equity, Diversity, and Inclusion (EDI) is gaining increased attention within all industries healthcare being no exception. The terminology Equity, Diversity, and Inclusion and its abbreviation EDI gained popularity in the early 2000's when varied socio-political factors prompted many organisations to examine EDI concepts and how to operationalise them. The growing diversity of our society requires cross-cultural inclusive approaches to increase equity and access to services. METHOD This unique research is community-led research supported by the British Oncology Pharmacy Association, in which the members of the BOPA community are equal partners to inform action on policies that address EDI. This research was a cross-sectional study involving an online survey of financial BOPA members. RESULTS Demographic data was extracted, and the quotes were analysed for common themes. The majority of respondents were women, and the largest age group was between 34 and 44. The first cause of microaggressions identified by the respondents was of racial and ethnic origin, followed by marital status and religious nature. Participants described the lack of diversity in senior positions and the microaggressions experienced by those who hold leadership positions. Some participants described how some situations at work made them feel excluded or alienated. The impact of discrimination and bullying/microaggressions extended to patients was also reported. CONCLUSION Despite strategic directions encompassing this aspect, this research underscores the pressing need for more evidence on the lack of EDI in healthcare institutions. Our findings, located in the pharmacy oncology specialty, have identified the problem and highlighted the potential benefits of addressing it. More needs to be done in training and professional development to address unconscious bias and change behaviours.
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Affiliation(s)
- Pascale Dettwiller
- Pharmacy Department, Department of Rural Health, The University of South Australia, Port Lincoln, South Australia, Australia
| | - Suhani Ghiya
- Pharmacy Department, The Rotherham NHS Foundation Trust, Rotherham, South Yorkshire, UK
| | - Jurga McLean
- Pharmacy Department, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - AdeDolapo Sanni
- Pharmacy Department, 15, Cornfield close, Sittingbourne, Kent, UK
| | - Nisha Shaunak
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lilia So
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steve Williamson
- National Institute for Health and Care Excellence (NICE), London, UK
| | - Shereen Nabhani-Gebara
- Pharmacy Department, Faculty of Health, Science, Social Care & Education, Kingston University, London, UK
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Tung N, Ricker C, Messersmith H, Balmaña J, Domchek S, Stoffel EM, Almhanna K, Arun B, Chavarri-Guerra Y, Cohen SA, Cragun D, Crew KD, Hall MJ, Idos G, Lopez G, Pal T, Pirzadeh-Miller S, Pritchard C, Rana HQ, Swami U, Vidal GA. Selection of Germline Genetic Testing Panels in Patients With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:2599-2615. [PMID: 38759122 DOI: 10.1200/jco.24.00662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE To guide use of multigene panels for germline genetic testing for patients with cancer. METHODS An ASCO Expert Panel convened to develop recommendations on the basis of a systematic review of guidelines, consensus statements, and studies of germline and somatic genetic testing. RESULTS Fifty-two guidelines and consensus statements met eligibility criteria for the primary search; 14 studies were identified for Clinical Question 4. RECOMMENDATIONS Patients should have a family history taken and recorded that includes details of cancers in first- and second-degree relatives and the patient's ethnicity. When more than one gene is relevant based on personal and/or family history, multigene panel testing should be offered. When considering what genes to include in the panel, the minimal panel should include the more strongly recommended genes from Table 1 and may include those less strongly recommended. A broader panel may be ordered when the potential benefits are clearly identified, and the potential harms from uncertain results should be mitigated. Patients who meet criteria for germline genetic testing should be offered germline testing regardless of results from tumor testing. Patients who would not normally be offered germline genetic testing based on personal and/or family history criteria but who have a pathogenic or likely pathogenic variant identified by tumor testing in a gene listed in Table 2 under the outlined circumstances should be offered germline testing.Additional information is available at www.asco.org/molecular-testing-and-biomarkers-guidelines.
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Affiliation(s)
- Nadine Tung
- Beth Israel Deaconess Medical Center, Sharon, MA
| | | | | | | | | | | | | | - Banu Arun
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yanin Chavarri-Guerra
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | - Gregory Idos
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ghecemy Lopez
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Tuya Pal
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Sara Pirzadeh-Miller
- Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Umang Swami
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Gregory A Vidal
- The West Cancer Center and Research Institute and The University of Tennessee Health Sciences Center, Germantown, TN
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Bower JE, Lacchetti C, Alici Y, Barton DL, Bruner D, Canin BE, Escalante CP, Ganz PA, Garland SN, Gupta S, Jim H, Ligibel JA, Loh KP, Peppone L, Tripathy D, Yennu S, Zick S, Mustian K. Management of Fatigue in Adult Survivors of Cancer: ASCO-Society for Integrative Oncology Guideline Update. J Clin Oncol 2024; 42:2456-2487. [PMID: 38754041 DOI: 10.1200/jco.24.00541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To update the ASCO guideline on the management of cancer-related fatigue (CRF) in adult survivors of cancer. METHODS A multidisciplinary panel of medical oncology, geriatric oncology, internal medicine, psychology, psychiatry, exercise oncology, integrative medicine, behavioral oncology, nursing, and advocacy experts was convened. Guideline development involved a systematic literature review of randomized controlled trials (RCTs) published in 2013-2023. RESULTS The evidence base consisted of 113 RCTs. Exercise, cognitive behavioral therapy (CBT), and mindfulness-based programs led to improvements in CRF both during and after the completion of cancer treatment. Tai chi, qigong, and American ginseng showed benefits during treatment, whereas yoga, acupressure, and moxibustion helped to manage CRF after completion of treatment. Use of other dietary supplements did not improve CRF during or after cancer treatment. In patients at the end of life, CBT and corticosteroids showed benefits. Certainty and quality of evidence were low to moderate for CRF management interventions. RECOMMENDATIONS Clinicians should recommend exercise, CBT, mindfulness-based programs, and tai chi or qigong to reduce the severity of fatigue during cancer treatment. Psychoeducation and American ginseng may be recommended in adults undergoing cancer treatment. For survivors after completion of treatment, clinicians should recommend exercise, CBT, and mindfulness-based programs; in particular, CBT and mindfulness-based programs have shown efficacy for managing moderate to severe fatigue after treatment. Yoga, acupressure, and moxibustion may also be recommended. Patients at the end of life may be offered CBT and corticosteroids. Clinicians should not recommend L-carnitine, antidepressants, wakefulness agents, or routinely recommend psychostimulants to manage symptoms of CRF. There is insufficient evidence to make recommendations for or against other psychosocial, integrative, or pharmacological interventions for the management of fatigue.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | - Yesne Alici
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra L Barton
- University of Tennessee, College of Nursing, Knoxville, TN
| | | | | | | | | | | | | | | | | | - Kah Poh Loh
- University of Rochester Medical Center, Rochester, NY
| | - Luke Peppone
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | | | | | | | - Karen Mustian
- University of Rochester Medical Center, Rochester, NY
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Arya S, Mahar A, Callum J, Haspel RL. Examining Injustices: Transfusion Medicine and Race. Transfus Med Rev 2024; 38:150822. [PMID: 38519336 DOI: 10.1016/j.tmrv.2024.150822] [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: 12/09/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 03/24/2024]
Abstract
Race and ethnicity are sociopolitical and not biological constructs, and assertions that these population descriptors have scientific meaning has caused significant harm. A critical assessment of the transfusion medicine literature is an important aspect of promoting race-conscious as opposed to race-based medicine. Utilizing current definitions and health equity frameworks, this review will provide a critical appraisal of transfusion medicine studies at the intersection of race and healthcare disparities, with a focus on larger methodological challenges facing the transfusion medicine community. Moving forward, risk modelling accounting for upstream factors, patient input, as well as an expert consensus on how to critically conduct and evaluate this type of literature are needed. Further, when using race and ethnicity in research contexts, investigators must be aware of existing guidelines for such reporting.
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Affiliation(s)
- Sumedha Arya
- Canadian Blood Services, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Alyson Mahar
- School of Nursing and Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jeannie Callum
- University of Toronto, Toronto, Ontario, Canada; Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | - Richard L Haspel
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Choradia N, Karzai F, Nipp R, Naqash AR, Gulley JL, Floudas CS. Increasing diversity in clinical trials: demographic trends at the National Cancer Institute, 2005-2020. J Natl Cancer Inst 2024; 116:1063-1071. [PMID: 38374401 PMCID: PMC11223850 DOI: 10.1093/jnci/djae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND We described participant demographics for National Cancer Institute (NCI) clinical trials at the clinical center (NCI-CC participants) of the National Institutes of Health to identify enrollment disparities. METHODS We analyzed NCI-CC data from 2005 to 2020, calculated enrollment fractions, compared with the US cancer population represented by the Surveillance, Epidemiology, and End Results cancer incidence data (2018) and the Cancer in North America database (2018), and compared further with clinical trial disparities data from the NCI Community Oncology Research Program and National Clinical Trials Network (2005-2019), and from ClinicalTrials.gov (2003-2016). RESULTS NCI-CC (38 531 participants) had higher enrollment fractions for older adults (8.5%), male (5.6%), non-Hispanic (5.1%), and Black or African American (5.3%) participants; lower women proportion across race and ethnicity; and fewer female sex-specific cancer (6.8%) than male sex-specific cancer (11.7%) participants. NCI-CC had lower median age than Surveillance, Epidemiology, and End Results (54.0 vs 65.4); more Black or African American participants (12.0% vs 11.1%); and fewer women (41.7% vs 49.5%), White (76.1% vs 80.5%), Asian or Pacific Islander (4.6% vs 6.0%), American Indian or Alaska Native (0.3% vs 0.5%), and Hispanic participants (7.1% vs 13%). NCI-CC had more Black or African American and Asian or Pacific Islander participants; fewer Hispanic participants than the NCI Community Oncology Research Program and National Clinical Trials Network; more Black or African American and Hispanic participants; fewer Asian or Pacific Islander participants than ClinicalTrials.gov data. Improvement was noted for NCI-CC (older adults, Black or African American, Asian or Pacific Islander, Hispanic participants). CONCLUSION We found lower representation of older adults, women, Asian or Pacific Islander, American Indian or Alaska Native, and Hispanic participants vs the US cancer population and higher representation of Black or African American vs US cancer population and oncology clinical trials. Multifaceted efforts are underway to reduce disparities in cancer clinical trials at the NCI-CC.
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Affiliation(s)
- Nirmal Choradia
- Medical Oncology Service, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Fatima Karzai
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Abdul Rafeh Naqash
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - James L Gulley
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charalampos S Floudas
- Center for Immuno-Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Mooney K, Beck SL, Wilson C, Coombs L, Whisenant M, Moraitis AM, Sloss EA, Alekhina N, Lloyd J, Steinbach M, Nicholson B, Iacob E, Donaldson G. Assessing Patient Perspectives and the Health Equity of a Digital Cancer Symptom Remote Monitoring and Management System. JCO Clin Cancer Inform 2024; 8:e2300243. [PMID: 39042843 DOI: 10.1200/cci.23.00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/05/2024] [Accepted: 05/31/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE People with cancer experience poorly controlled symptoms that persist between treatment visits. Automated digital technology can remotely monitor and facilitate symptom management at home. Essential to digital interventions is patient engagement, user satisfaction, and intervention benefits that are distributed across patient populations so as not to perpetuate inequities. We evaluated Symptom Care at Home (SCH), an automated digital platform, to determine patient engagement, satisfaction, and whether intervention subgroups gained similar symptom reduction benefits. METHODS 358 patients with cancer receiving a course of chemotherapy were randomly assigned to SCH or usual care (UC). Both groups reported daily on 11 symptoms and completed the SF36 (Short Form Health Survey) monthly. SCH participants received immediate automated self-care coaching on reported symptoms. As needed, nurse practitioners followed up for poorly controlled symptoms. RESULTS The average participant was White (83%), female (75%), and urban-dwelling (78.6%). Daily call adherence was 90% of expected days. Participants reported high user satisfaction. SCH participants had lower symptom burden than UC in all subgroups: age, sex, race, income, residence type, diagnosis, and stage (all P < .001 effect size 0.33-0.65), except for stages I and II cancers. Non-White and lower-income SCH participants gained a higher magnitude of symptom reduction than White participants and higher-income participants. Additionally, SCH men gained higher SF36 mental health (MH) benefit. There were no differences on other SF36 indices. CONCLUSION Participants were highly satisfied and consistently engaged the SCH platform. SCH men gained large MH improvements, perhaps from increased comfort in sharing concerns through automated interactions. Although all intervention subgroups benefited, non-White participants and those with lower income gained higher symptom reduction benefit, suggesting that systematic care through digital tools can overcome existing disparities in symptom care outcomes.
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Affiliation(s)
- Kathi Mooney
- College of Nursing, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Susan L Beck
- College of Nursing, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Christina Wilson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Lorinda Coombs
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Meagan Whisenant
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ann Marie Moraitis
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA
| | | | | | - Jennifer Lloyd
- College of Nursing, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Mary Steinbach
- College of Nursing, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Gary Donaldson
- College of Nursing, University of Utah, Salt Lake City, UT
- School of Medicine, University of Utah, Salt Lake City, UT
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13
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Sanders JJ, Temin S, Ghoshal A, Alesi ER, Ali ZV, Chauhan C, Cleary JF, Epstein AS, Firn JI, Jones JA, Litzow MR, Lundquist D, Mardones MA, Nipp RD, Rabow MW, Rosa WE, Zimmermann C, Ferrell BR. Palliative Care for Patients With Cancer: ASCO Guideline Update. J Clin Oncol 2024; 42:2336-2357. [PMID: 38748941 DOI: 10.1200/jco.24.00542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To provide evidence-based guidance to oncology clinicians, patients, nonprofessional caregivers, and palliative care clinicians to update the 2016 ASCO guideline on the integration of palliative care into standard oncology for all patients diagnosed with cancer. METHODS ASCO convened an Expert Panel of medical, radiation, hematology-oncology, oncology nursing, palliative care, social work, ethics, advocacy, and psycho-oncology experts. The Panel conducted a literature search, including systematic reviews, meta-analyses, and randomized controlled trials published from 2015-2023. Outcomes of interest included quality of life (QOL), patient satisfaction, physical and psychological symptoms, survival, and caregiver burden. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 52 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions. Oncology clinicians from across the interdisciplinary cancer care team may refer the caregivers (eg, family, chosen family, and friends) of patients with cancer to palliative care teams for additional support. The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
| | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Arun Ghoshal
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Erin R Alesi
- Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
| | | | | | - James F Cleary
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | | | | | - Michael W Rabow
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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14
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Bellizzi KM, Fritzson E, Ligus K, Park CL. Social Support Buffers the Effect of Social Deprivation on Comorbidity Burden in Adults with Cancer. Ann Behav Med 2024:kaae035. [PMID: 38935875 DOI: 10.1093/abm/kaae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Adults with cancer have higher rates of comorbidity compared to those without cancer, with excess burden in people from lower socioeconomic status (SES). Social deprivation, based on geographic indices, broadens the focus of SES to include the importance of "place" and its association with health. Further, social support is a modifiable resource found to have direct and indirect effects on health in adults with cancer, with less known about its impact on comorbidity. PURPOSE We prospectively examined associations between social deprivation and comorbidity burden and the potential buffering role of social support. METHODS Our longitudinal sample of 420 adults (Mage = 59.6, SD = 11.6; 75% Non-Hispanic White) diagnosed with cancer completed measures at baseline (~6 months post-diagnosis) and four subsequent 3-month intervals for 1 year. RESULTS Adjusting for age, cancer type, and race/ethnicity, we found a statistically significant interaction between social support and the effect of social deprivation on comorbidity burden (β = -0.11, p = 0.012), such that greater social support buffered the negative effect of social deprivation on comorbidity burden. CONCLUSION Implementing routine screening for social deprivation in cancer care settings can help identify patients at risk of excess comorbidity burden. Clinician recognition of these findings could trigger a referral to social support resources for individuals high on social deprivation.
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Affiliation(s)
- Keith M Bellizzi
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, Storrs, CT, USA
| | - Emily Fritzson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, Storrs, CT, USA
| | - Kaleigh Ligus
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Road, Storrs, CT, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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15
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Shilling DM, Manz CR, Strand JJ, Patel MI. Let Us Have the Conversation: Serious Illness Communication in Oncology: Definitions, Barriers, and Successful Approaches. Am Soc Clin Oncol Educ Book 2024; 44:e431352. [PMID: 38788187 DOI: 10.1200/edbk_431352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Serious illness communications are crucial elements of care delivery for patients with cancer. High-quality serious illness communications are composed of open, honest discussions between patients, caregivers, and clinicians regarding patient's communication preferences, expected illness trajectory, prognosis, and risks and benefits of any recommended care. High-quality communication ideally starts at the time of a patients' cancer diagnosis, allows space for and response to patient emotions, elicits patients' values and care preferences, and is iterative and longitudinal. When integrated into cancer care, such communication can result in improved patient experiences with their care, care that matches patients' goals, and reduced care intensity at the end of life. Despite national recommendations for routine integration of these communication into cancer care, a minority of patients with cancer receive such communication. In this chapter, we describe elements of high-quality serious illness communication, patient-, clinician-, institution-, and payer-level barriers, and successful strategies that can routinely integrate such communication into cancer care delivery.
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Affiliation(s)
- Danielle M Shilling
- Division of Community Internal Medicine, Geriatrics & Palliative Care, Mayo Clinic, Rochester, MN
| | - Christopher R Manz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jacob J Strand
- Division of Community Internal Medicine, Geriatrics & Palliative Care, Mayo Clinic, Rochester, MN
| | - Manali I Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
- VA Palo Alto Health Care System, Palo Alto, CA
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16
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Graboyes EM, Cagle JL, Ramadan S, Prasad K, Yan F, Pearce J, Mazul AL, Anoma JS, Hill EG, Chera BS, Puram SV, Jackson R, Sandulache VC, Tam S, Topf MC, Kahmke R, Osazuwa-Peters N, Nussenbaum B, Alberg AJ, Sterba KR, Halbert CH. Neighborhood-Level Disadvantage and Delayed Adjuvant Therapy in Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:472-482. [PMID: 38662392 PMCID: PMC11046410 DOI: 10.1001/jamaoto.2024.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
Importance For patients with head and neck squamous cell carcinoma (HNSCC), initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is recommended by the National Comprehensive Cancer Network Guidelines and the Commission on Cancer. Although individual-level measures of socioeconomic status are associated with receipt of timely, guideline-adherent PORT, the role of neighborhood-level disadvantage has not been examined. Objective To characterize the association of neighborhood-level disadvantage with delays in receiving PORT. Design, Setting, and Participants This retrospective cohort study included 681 adult patients with HNSCC undergoing curative-intent surgery and PORT from 2018 to 2020 at 4 US academic medical centers. The data were analyzed between June 21, 2023, and March 5, 2024. Main Outcome Measures and Measures The primary outcome was delay in initiating guideline-adherent PORT (ie, >6 weeks after surgery). Time-to-PORT (TTP) was a secondary outcome. Census block-level Area Deprivation Index (ADI) scores were calculated and reported as national percentiles (0-100); higher scores indicate greater deprivation. The association of ADI scores with PORT delay was assessed using multivariable logistic regression adjusted for demographic, clinical, and institutional characteristics. PORT initiation across ADI score population quartiles was evaluated with cumulative incidence plots and Cox models. Results Among 681 patients with HNSCC undergoing surgery and PORT (mean [SD] age, 61.5 [11.2] years; 487 [71.5%] men, 194 [29.5%] women) the PORT delay rate was 60.8% (414/681) and median (IQR) TTP was 46 (40-56) days. The median (IQR) ADI score was 62.0 (44.0-83.0). Each 25-point increase in ADI score was associated with a corresponding 32% increase in the adjusted odds ratio (aOR) of PORT delay (aOR, 1.32; 95% CI, 1.07-1.63) on multivariable regression adjusted for institution, age, race and ethnicity, insurance, comorbidity, cancer subsite, stage, postoperative complications, care fragmentation, travel distance, and rurality. Increasing ADI score population quartiles were associated with increasing TTP (hazard ratio of PORT initiation, 0.71; 95% CI, 0.53-0.96; 0.59; 95% CI, 0.44-0.77; and 0.54; 95% CI, 0.41-0.72; for ADI quartiles 2, 3, and 4 vs ADI quartile 1, respectively). Conclusions and Relevance Increasing neighborhood-level disadvantage was independently associated with a greater likelihood of PORT delay and longer TTP in a dose-dependent manner. These findings indicate a critical need for the development of multilevel strategies to improve the equitable delivery of timely, guideline-adherent PORT.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Joshua Lee Cagle
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Salma Ramadan
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Kavita Prasad
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Flora Yan
- Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - John Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Angela L. Mazul
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jean-Sebastien Anoma
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Bhisham S. Chera
- Hollings Cancer Center, Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Sidharth V. Puram
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Ryan Jackson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Samantha Tam
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health, Detroit, Michigan
| | - Michael C. Topf
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Otolaryngology–Head & Neck Surgery
| | - Brian Nussenbaum
- American Board of Otolaryngology–Head and Neck Surgery, Houston, Texas
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia
| | - Katherine R. Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
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Lynch PA, Gillette JM, Sheche JN, Jaffe SA, Rodman J, Cartwright K, Kano M, Mishra SI. Stepping Up Summer Fun: the Cancer Research - Scholarship and Training Experience in Population Sciences (C-STEPS) Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02458-1. [PMID: 38819526 DOI: 10.1007/s13187-024-02458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
Over the last two decades, strides in cancer prevention, earlier detection, and novel treatments have reduced overall cancer mortality; however, cancer health disparities (CHD) persist among demographically diverse and intersecting populations. The development of a culturally responsive workforce trained in interdisciplinary, team-based science is a key strategy for addressing these cancer disparities. The Cancer Research - Scholarship and Training Experience in Population Sciences (C-STEPS) program at the University of New Mexico Comprehensive Cancer Center is designed to increase and diversify the biomedical and behavioral research workforce by providing specialized and experiential curricula that highlight team-oriented cancer control and population science. Undergraduate students interested in CHD and in pursuing STEM-H (science, technology, engineering, mathematics, and health) graduate or professional degrees are eligible for the program. C-STEPS students are paired with a UNM faculty mentor, who guides the student's 10-week summer research experience. They receive mentorship and support from three layers-faculty, near-peers (graduate students), and peers (undergraduates who have completed the C-STEPS program previously). Students generate five products, including a capstone presentation, grounded in the research they conduct with their faculty mentors. Since its founding in 2021, C-STEPS has trained three cohorts with a total of 32 students. The C-STEPS program provides a unique team-science approach with multilayer mentoring to create a sustainable pipeline for the development of students interested in STEM-H fields and CHD research. The capstone project led to 47% of students presenting their work at conferences, and two publishing their manuscripts in peer-reviewed journals. Overall, 89% of students were either "satisfied" or "very satisfied" with the program and the same percentage recommended the program to other undergraduates.
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Affiliation(s)
- Paige A Lynch
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jennifer M Gillette
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
- Comprehensive Cancer Center, University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Judith N Sheche
- Comprehensive Cancer Center, University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Shoshana Adler Jaffe
- Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Joseph Rodman
- Comprehensive Cancer Center, University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Kate Cartwright
- School of Public Administration, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Miria Kano
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA.
- Departments of Pediatrics and Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA.
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18
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Keruakous AR, Akpan I, Chahin M, Kirolos A, Keruakous M. Equity in oncology care: addressing disparities in cancer treatment in Georgia. Front Public Health 2024; 12:1381075. [PMID: 38756877 PMCID: PMC11098010 DOI: 10.3389/fpubh.2024.1381075] [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: 02/02/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
This research delves into the disparities in access to oncology care among cancer patients in Georgia, with a specific focus on the distinct challenges faced by African American (AA) individuals compared to non-African American (Non-AA) counterparts. Leveraging data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey and supplementary online resources, the study meticulously examines socioeconomic factors, including income, education, and insurance coverage, which significantly influence the quality of cancer care received. The analysis reveals substantial income gaps between AA and Non-AA patients, underscoring the critical implications for healthcare access. Moreover, AA patients exhibit lower rates of full insurance coverage for cancer-related treatments, posing additional barriers to comprehensive care. By investigating the intersections of race, income, and education, the research aims to pinpoint the root causes of these disparities and proposes evidence-based solutions to address the identified challenges. The ultimate objective is to contribute valuable insights that inform targeted policy recommendations and community-based interventions, fostering a more equitable landscape for oncology care in Georgia. This study seeks to amplify awareness and advocate for tangible measures, striving toward healthcare equity for all cancer patients, irrespective of their racial or socioeconomic backgrounds.
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Affiliation(s)
- Amany R. Keruakous
- Hematology Oncology Department, Georgia Cancer Center, Wellstar MCG Health, Augusta, GA, United States
| | | | - Michael Chahin
- Hematology Oncology Department, Georgia Cancer Center, Wellstar MCG Health, Augusta, GA, United States
| | | | - Mai Keruakous
- Mercer County Community College, Trenton, NJ, United States
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19
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Hussaini SMQ, Fan Q, Barrow LCJ, Yabroff KR, Pollack CE, Nogueira LM. Association of Historical Housing Discrimination and Colon Cancer Treatment and Outcomes in the United States. JCO Oncol Pract 2024; 20:678-687. [PMID: 38320228 DOI: 10.1200/op.23.00426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE In the 1930s, the federally sponsored Home Owners' Loan Corporation (HOLC) used racial composition in its assessment of areas worthy of receiving loans. Neighborhoods with large proportions of Black residents were mapped in red (ie, redlining) and flagged as hazardous for mortgage financing. Redlining created a platform for systemic disinvestment in these neighborhoods, leading to barriers in access to resources that persist today. We investigated the association between residing in areas with different HOLC ratings and receipt of quality cancer care and outcomes among individuals diagnosed with colon cancer-a leading cause of cancer deaths amenable to early detection and treatment. METHODS Individuals who resided in zip code tabulation areas in 196 cities with HOLC rating and were diagnosed with colon cancer from 2007 to 2017 were identified from the National Cancer Database and assigned a HOLC grade (A, best; B, still desirable; C, definitely declining; and D, hazardous and mapped in red). Multivariable logistic regression models investigated association of area-level HOLC grade and late stage at diagnosis and receipt of guideline-concordant care. The product-limit method evaluated differences in time to adjuvant chemotherapy. Multivariable Cox proportional hazard models investigated differences in overall survival (OS). RESULTS There were 149,917 patients newly diagnosed with colon cancer with a median age of 68 years. Compared with people living in HOLC A areas, people living in HOLC D areas were more likely to be diagnosed with late-stage disease (adjusted odds ratio, 1.06 [95% CI, 1.00 to 1.12]). In addition, people living in HOLC B, C, and D areas had 8%, 16%, and 24% higher odds of not receiving guideline-concordant care, including lower receipt of surgery, evaluation of ≥12 lymph nodes, and chemotherapy. People residing in HOLC B, C, or D areas also experienced delays in initiation of adjuvant chemotherapy after surgery. People residing in HOLC C (adjusted hazard ratio [aHR], 1.09 [95% CI, 1.05 to 1.13]) and D (aHR, 1.13 [95% CI, 1.09 to 1.18]) areas had worse OS, including 13% and 20% excess risk of death for individuals diagnosed with early- and 6% and 8% for late-stage disease for HOLC C and D, respectively. CONCLUSION Historical housing discrimination is associated with worse contemporary access to colon cancer care and outcomes.
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Affiliation(s)
- S M Qasim Hussaini
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Qinjin Fan
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Lauren C J Barrow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, MD
| | - Leticia M Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
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20
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Tucker-Seeley R, Abu-Khalaf M, Bona K, Shastri S, Johnson W, Phillips J, Masood A, Moushey A, Hinyard L. Social Determinants of Health and Cancer Care: An ASCO Policy Statement. JCO Oncol Pract 2024; 20:621-630. [PMID: 38386945 DOI: 10.1200/op.23.00810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
ASCO's new policy statement on SDOH supports practices that sustain and advance cancer health equity.
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Affiliation(s)
| | | | | | | | | | | | - Azam Masood
- American Society of Clinical Oncology, Alexandria, VA
| | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, VA
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Patel MI, Hinyard L, Merrill JK, Smith KT, Lei J, Carrizosa D, Kamaraju S, Hlubocky FJ, Kalwar T, Fashoyin-Aje L, Gomez SL, Jeames S, Florez N, Kircher SM, Tap WD. Challenges and Solutions to Support Oncology Professionals Serving Underserved Populations With Cancer in the United States: Results From the ASCO Serving the Underserved Task Force. JCO Oncol Pract 2024; 20:688-698. [PMID: 38354324 DOI: 10.1200/op.23.00595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Little data exist regarding approaches to support oncology professionals who deliver cancer care for underserved populations. In response, ASCO developed the Serving the Underserved Task Force to learn from and support oncology professionals serving underserved populations. METHODS The Task Force developed a 28-question survey to assess oncology professionals' experiences and strategies to support their work caring for underserved populations. The survey was deployed via an online link to 600 oncology professionals and assessed respondent and patient demographic characteristics, clinic-based processes to coordinate health-related social services, and strategies for professional society support and engagement. We used chi-square tests to evaluate whether there were associations between percent full-time equivalent (FTE) effort serving underserved populations (<50% FTE v ≥50% FTE) with responses. RESULTS Of 462 respondents who completed the survey (77% response rate), 79 (17.1%) were Asian; 30 (6.5%) Black; 43 (9.3%) Hispanic or Latino/Latina; and 277 (60%) White. The majority (n = 366, 79.2%) had a medical doctor degree (MD). A total of 174 (37.7%) had <25% FTE, 151 (32.7%) had 25%-50% FTE, and 121 (26.2%) had ≥50% FTE effort serving underserved populations. Most best guessed patients' sociodemographic characteristics (n = 388; 84%), while 42 (9.2%) used data collected by the clinic. Social workers coordinated most health-related social services. However, in clinical settings with high proportions of underserved patients, there was greater reliance on nonclinical personnel, such as navigators (odds ratio [OR], 2.15 [95% CI, 1.07 to 4.33]) or no individual (OR, 2.55 [95% CI, 1.14 to 5.72]) for addressing mental health needs and greater reliance on physicians or advance practice practitioners (OR, 2.54 [95% CI, 1.11 to 5.81]) or no individual (OR, 1.91 [95% CI, 1.09 to 3.35]) for addressing childcare or eldercare needs compared with social workers. Prioritization of solutions, which did not differ by FTE effort serving underserved populations, included a return-on-investment model to support personnel, integrated health-related social needs screening, and collaboration with the professional society on advocacy and policy. CONCLUSION The findings highlight crucial strategies that professional societies can implement to support oncology clinicians serving underserved populations with cancer.
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Affiliation(s)
- Manali I Patel
- Stanford University School of Medicine, Stanford, CA
- VA Palo Alto Health Care System, Palo Alto, CA
| | | | | | | | - Jennifer Lei
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | - Tricia Kalwar
- Veterans Administration, Miami Healthcare System, Miami, FL
| | | | | | | | - Narjust Florez
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - William D Tap
- Memorial Sloan Kettering Cancer Center, New York, NY
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22
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Michaels M, Weiss ES, Sae‐Hau M, Illei D, Lilly B, Szumita L, Connell B, Lee M, Cooks E, McPheeters M. Strategies for increasing accrual in cancer clinical trials: What is the evidence? Cancer Med 2024; 13:e7298. [PMID: 38770644 PMCID: PMC11106681 DOI: 10.1002/cam4.7298] [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: 01/10/2024] [Revised: 04/15/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Despite the importance of clinical trial participation among cancer patients, few participate-and even fewer patients from ethnic and racial minoritized groups. It is unclear whether suggested approaches to increase accrual are successful. We conducted a scoping review to identify evidence-based approaches to increase participation in cancer treatment clinical trials that demonstrated clear increases in accrual. Notably, more stringent than other published reviews, only those studies with comparison data to measure a difference in accrual rates were included. METHODS We searched PubMed/MEDLINE, Embase, CINAHL, and Web of Science for English-language articles published from January 1, 2012, to August 8, 2022. Studies were included if they were conducted in the United States, described single or multicomponent interventions, and provided data to measure accrual relative to baseline levels or that compared accrual rates with other interventions. RESULTS Sixteen articles were included: six with interventions addressing patient barriers, two addressing provider barriers, seven describing institutional change, and one describing policy change. Key themes emerged, such as a focus on patient education, cultural competency, and building the capacity of clinics. Few studies provide comparative accrual data, making it difficult to identify with certainty any effective, evidence-based approaches for increasing accrual. Some patient- and system-level interventions studies showed modest increases in accrual primarily through pre-post measurement. CONCLUSION Despite an extensive body of literature about the barriers that impede cancer treatment trial accrual, along with numerous recommendations for how to overcome these barriers, results reveal surprisingly little evidence published in the last 10 years on interventions that increase accrual relative to baseline levels or compared with other interventions. As clinical trials are a primary vehicle through which we improve cancer care, it is critical that evidence-based approaches are used to inform all efforts to increase accrual. Strategies for increasing participation in cancer clinical trials must be developed and rigorously evaluated so that these strategies can be disseminated, participation in trials can increase and become more equitable, and trial results can become more generalizable.
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Affiliation(s)
- Margo Michaels
- Health Access and Action ConsultingNewtonMassachusettsUSA
| | | | | | - Dora Illei
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | | | - Leah Szumita
- The Leukemia & Lymphoma SocietyNew YorkNew YorkUSA
| | | | | | - Eric Cooks
- The Leukemia & Lymphoma SocietyNew YorkNew YorkUSA
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Budhu JA, Chukwueke UN, Jackson S, Lee EQ, McFaline-Figueroa JR, Willmarth N, Dalmage M, Kawachi I, Arons D, Chang SM, Galanis E, Hervey-Jumper SL, Wen PY, Porter AB. Defining interventions and metrics to improve diversity in CNS clinical trial participation: A SNO and RANO effort. Neuro Oncol 2024; 26:596-608. [PMID: 38071654 PMCID: PMC10995510 DOI: 10.1093/neuonc/noad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Despite major strides in cancer research and therapy, these advances have not been equitable across race and ethnicity. Historically marginalized groups (HMG) are more likely to have inadequate preventive screening, increased delays in diagnosis, and poor representation in clinical trials. Notably, Black, Hispanic, and Indigenous people represent 30% of the population but only 9% of oncology clinical trial participants. As a result, HMGs lack equitable access to novel therapies, contradicting the principle of distributive justice, as enshrined in the Belmont report, which demands the equitable selection of subjects in research involving human subjects. The lack of clinical trial diversity also leads to low generalizability and potentially harmful medical practices. Specifically, patients with brain cancer face unique barriers to clinical trial enrollment and completion due to disease-specific neurologic and treatment-induced conditions. Collectively, the intersection of these disease-specific conditions with social determinants of health fosters a lack of diversity in clinical trials. To ameliorate this disparity in neuro-oncology clinical trial participation, we present interventions focused on improving engagement of HMGs. Proposals range from inclusive trial design, decreasing barriers to care, expanding trial eligibility, access to tumor profiling for personalized medical trials, setting reasonable metrics and goals for accrual, working with patient community stakeholders, diversifying the neuro-oncology workforce, and development of tools to overcome biases with options to incentivize equity. The diversification of participation amongst neuro-oncology clinical trials is imperative. Equitable access and inclusion of HMG patients with brain tumors will not only enhance research discoveries but will also improve patient care.
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Affiliation(s)
- Joshua A Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Neurology, Weill Cornell Medicine, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Ugonma N Chukwueke
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sadhana Jackson
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eudocia Q Lee
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Ricardo McFaline-Figueroa
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mahalia Dalmage
- Division of Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David Arons
- National Brain Tumor Society, Newton, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco and Weill Institute for Neurosciences, San Francisco, California, USA
| | - Patrick Y Wen
- Division of Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyx B Porter
- Department of Neurology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA
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24
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Balogun Z, Gardiner LA, Li J, Moroni EA, Rosenzweig M, Nilsen ML. Neighborhood Deprivation and Symptoms, Psychological Distress, and Quality of Life Among Head and Neck Cancer Survivors. JAMA Otolaryngol Head Neck Surg 2024; 150:295-302. [PMID: 38386337 PMCID: PMC10884950 DOI: 10.1001/jamaoto.2023.4672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/21/2023] [Indexed: 02/23/2024]
Abstract
Importance Socioeconomic deprivation is associated with increased risk of poor health and quality-of-life (QOL) outcomes in head and neck cancer (HNC) survivors. However, there are few data on how neighborhood deprivation affects patient-reported outcome measures (PROMs) in HNC survivors. Objective To investigate whether neighborhood socioeconomic deprivation is associated with symptom burden, psychological distress, and QOL among HNC survivors. Design, Setting, and Participants This cross-sectional study used prospectively collected data from patients seen in a university-affiliated multidisciplinary HNC survivorship clinic between September 2018 and September 2021 who received radiotherapy for squamous cell carcinoma of the oral cavity, oropharynx, and larynx or hypopharynx. Exposure Neighborhood socioeconomic deprivation, measured using the Area Deprivation Index (ADI). Main Outcomes and Measures The PROMs pertaining to symptom burden and severity of psychological distress were measured using the Neck Disability Index, Insomnia Severity Index, the 10-item Eating Assessment Tool, the Generalized Anxiety Disorder 7-item scale, and the 8-item Patient Health Questionnaire. Physical and social-emotional QOL were obtained using the University of Washington QOL questionnaire. Multivariable linear regression analysis adjusting for individual-level sociodemographic, comorbidity, and treatment characteristics investigated the association between ADI and PROMs. A subgroup analysis was performed to compare the lowest (most affluent areas: ADI, 0%-20%) and highest (most deprived areas: ADI, 80%-100%) ADI quintiles. Results A total of 277 patients were included in the final analysis (mean [SD] age, 64.18 [9.60] years; 215 [77.6%] male). Cancer sites were the oral cavity (52 [18.8%]), oropharyngeal area (171 [61.7%]), and larynx or hypopharynx (54 [19.5%]). Multivariable analysis showed that for every 1-point increase in ADI, social-emotional QOL changed by -0.14 points (95% CI, -0.24 to -0.05 points), anxiety increased by 0.03 points (95% CI, 0.01-0.06 points), and neck disability worsened by 0.05 points (95% CI, 0.01-0.10 points). Compared with patients in the most affluent areas, those in the most deprived areas had significantly lower physical (-15.89 points; 95% CI, -25.96 to -2.31 points; Cohen d = -0.83) and social-emotional (-13.57 points; 95% CI, -22.79 to -3.49 points; Cohen d = -0.69) QOL and higher depression (2.60 points; 95% CI, 0.21-4.40 points; Cohen d = 0.52), anxiety (3.12 points; 95% CI, 1.56-4.66 points; Cohen d = 0.61), insomnia (3.55 points; 95% CI, 0.33-6.41 points; Cohen d = 0.54), and neck disability (5.65 points; 95% CI, 1.66-9.55 points; Cohen d = 0.66) scores. Conclusions and Relevance In this cross-sectional study, a higher ADI score was associated with higher risk of increased psychological distress, higher symptom burden, and decreased QOL after treatment among HNC survivors. These findings suggest that proactive, patient-centered interventions are needed to address these disparities.
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Affiliation(s)
- Zainab Balogun
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lauren A. Gardiner
- Department of Otolaryngology, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jinhong Li
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth A. Moroni
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Margaret Rosenzweig
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marci Lee Nilsen
- Department of Otolaryngology, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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25
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Liang D, House SA, Moriates C. Improving healthcare value: The need to explicitly address equity in high-value care. J Hosp Med 2024; 19:316-319. [PMID: 38230886 DOI: 10.1002/jhm.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/09/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Danni Liang
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samantha A House
- Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire, USA
| | - Christopher Moriates
- Department of Medicine, VA Greater Los Angeles Healthcare System and UCLA, Los Angeles, California, USA
- Costs of Care, Boston, Massachusetts, USA
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Al Sukhun SA, Vanderpuye V, Taylor C, Ibraheem AF, Wiernik Rodriguez A, Asirwa FC, Francisco M, Moushey A. Global Equity in Clinical Trials: An ASCO Policy Statement. JCO Glob Oncol 2024; 10:e2400015. [PMID: 38484198 PMCID: PMC10954071 DOI: 10.1200/go.24.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/19/2024] Open
Abstract
ASCO is a global professional society representing more than 50,000 physicians, other health care professionals, and advocates in over 100 countries specializing in cancer treatment, diagnosis, prevention, and advocacy. ASCO strives, through research, education, and promotion of the highest quality of patient care, to create a world where cancer is prevented or cured, and every survivor is healthy. In this pursuit, health equity remains the guiding institutional principle that applies to all its activities across the cancer care continuum. This ASCO policy statement emphasizes the urgent need for global equity in clinical trials, aiming to enhance access and representation in cancer research as it not only improves cancer outcomes but also upholds principles of fairness and justice in health care.
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Affiliation(s)
| | - Verna Vanderpuye
- National Center for Radiotherapy Ghana, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Andres Wiernik Rodriguez
- Grupo Montecristo Healthcare Division, San José, Escazu, Costa Rica
- Hospital Metropolitano, San José, Costa Rica
- Metropolitano Research Institute, San José, Costa Rica
| | - Fredrick Chite Asirwa
- International Cancer Institute, Kenya International Cancer Institute | ICI, Eldoret, Kenya
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Smith M, Kurup S, Devaraja K, Shanawaz S, Reynolds L, Ross J, Bezjak A, Gupta AA, Kassam A. Adapting an Adolescent and Young Adult Program Housed in a Quaternary Cancer Centre to a Regional Cancer Centre: Creating Equitable Access to Developmentally Tailored Support. Curr Oncol 2024; 31:1266-1277. [PMID: 38534928 PMCID: PMC10969112 DOI: 10.3390/curroncol31030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/15/2024] [Accepted: 02/23/2024] [Indexed: 05/26/2024] Open
Abstract
Adolescents and young adults (AYAs) with cancer, representing those between 15 and 39 years of age, face distinctive challenges balancing their life stage with the physical, emotional, and social impacts of a cancer diagnosis. These challenges include fertility concerns, disruptions to educational and occupational pursuits, issues related to body image and sexual health, and the need for age-appropriate psychosocial support within their communities. The Princess Margaret Cancer Centre (PM), a quaternary care center, established a specialized AYA program in 2014, offering holistic and developmentally tailored psychosocial support and currently, efforts are underway to expand this to other regions in the province to address the need for equitable access. The establishment process involves securing funding, conducting an environmental scan, identifying service gaps, developing clinical pathways, and implementing AYA supportive care. An accessible AYA program should also consider social determinants of health, social location, intersectionality, and an interdisciplinary health approach in understanding health inequities in AYA oncology care. This paper describes the processes implemented and challenges faced in creating a community-based AYA program beyond major resource-rich cities and efforts to address intersectionality.
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Affiliation(s)
- Marlie Smith
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
- Adolescent and Young Adult Program, Department of Supportive Care, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, ON L3Y 2P9, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Simone Kurup
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
| | - Kaviya Devaraja
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
| | - Shaayini Shanawaz
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
| | - Lorrie Reynolds
- Central Regional Cancer Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, ON L3Y 2P9, Canada;
| | - Jill Ross
- Childhood Cancer Care, Pediatric Oncology Group of Ontario, Toronto, ON M5G 1V2, Canada;
| | - Andrea Bezjak
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Abha A. Gupta
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Alisha Kassam
- Department of Pediatrics, Southlake Regional Health Centre, Newmarket, ON L3Y 2P9, Canada;
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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28
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Somayaji D, Mohedat H, Li CS. Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care. Cancer Nurs 2024:00002820-990000000-00215. [PMID: 38416076 DOI: 10.1097/ncc.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods. OBJECTIVE This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment. METHODS A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person. RESULTS Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment. CONCLUSIONS The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care. IMPLICATIONS FOR PRACTICE Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.
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Affiliation(s)
- Darryl Somayaji
- Author Affiliation: School of Nursing, University at Buffalo (Dr Somayaji and Mrs Mohedat), New York; and Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center (Dr Li), Rochester, New York
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29
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Mezzacappa C, Rossi R, Jaffe A, Taddei TH, Strazzabosco M. Community-Level Factors Associated with Hepatocellular Carcinoma Incidence and Mortality: An Observational Registry Study. Cancer Epidemiol Biomarkers Prev 2024; 33:270-278. [PMID: 38059831 PMCID: PMC10872555 DOI: 10.1158/1055-9965.epi-23-0902] [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: 08/04/2023] [Revised: 10/23/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) incidence and outcomes vary across populations in the United States, but few studies evaluate local drivers of observed disparities. We measured HCC incidence at the community level and assessed community-level HCC risk factors with the goal of informing resource allocation to improve early case detection, which is associated with improved outcomes. METHODS Clinical and demographic data including census tract of residence for all adults diagnosed with HCC in the Connecticut Tumor Registry between 2008 and 2019 were combined with publicly available U.S. Census and Centers for Disease Control and Prevention (CDC) data at the ZIP Code tabulation area (ZCTA) level. The average annual incidence of HCC was calculated for each ZCTA and associations between community-level characteristics, HCC incidence, stage at diagnosis, and survival were evaluated. RESULTS Average annual HCC incidence during the study period was 8.9/100,000 adults and varied from 0 to 97.7 per 100,000 adults by ZCTA. At the community level, lower rates of high school graduation, higher rates of poverty, and rural community type were associated with higher HCC incidence. Persons with HCC living in the highest incidence ZCTAs were diagnosed at a younger age and were less likely to be alive at 1, 2, and 5 years after diagnosis. CONCLUSIONS Community-level socioeconomic factors are strongly associated with HCC incidence and survival in Connecticut. IMPACT This reproducible geo-localization approach using cancer registry, Census, and CDC data can be used to identify communities most likely to benefit from health system investments to reduce disparities in HCC.
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Affiliation(s)
- Catherine Mezzacappa
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
| | - Raiza Rossi
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
| | - Ariel Jaffe
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
- Yale Cancer Center
| | - Tamar H Taddei
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
- Yale Cancer Center
- VA Connecticut Healthcare System
| | - Mario Strazzabosco
- Yale Liver Center, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine
- Yale Cancer Center
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30
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Smith SM, Teer A, Tolamatl Ariceaga E, Billman E, Benedict C, Goyal A, Pang EM, Pecos-Duarte C, Lewinsohn R, Smith M, Boynton H, Montes S, Rivera E, Ramirez D, Schapira L. A qualitative study of childhood cancer families' post-treatment needs and the impact of a community-based organization in a rural, socioeconomically disadvantaged, majority Hispanic/Latino region. Pediatr Blood Cancer 2024; 71:e30798. [PMID: 38053230 DOI: 10.1002/pbc.30798] [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: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Individual- and population-level socioeconomic disadvantages contribute to unequal outcomes among childhood cancer survivors. Reducing health disparities requires understanding experiences of survivors from historically marginalized communities, including those with non-English language preference. PROCEDURE We partnered with a community-based organization (CBO) serving families of children with cancer in a rural region in California with low socioeconomic status and majority Hispanic/Latino (H/L) residents. We interviewed English- and Spanish-speaking adolescent/young adult (AYA) childhood cancer survivors (≥15 years old, ≥5 years from diagnosis), parents, and CBO staff to evaluate post-treatment needs and impact of CBO support. Data were analyzed qualitatively using applied thematic analysis. Themes were refined through team discussions with our community partners. RESULTS Twelve AYAs (11 H/L, 11 bilingual), 11 parents (eight H/L, seven non-English preferred), and seven CBO staff (five H/L, five bilingual) participated. AYAs (five female, seven male) were of median (min-max) age 20 (16-32) and 9 (5-19) years post diagnosis; parents (nine female, two male) were age 48 (40-60) and 14 (6-23) years post child's diagnosis. Themes included challenges navigating healthcare, communication barriers among the parent-AYA-clinician triad, and lasting effects of childhood cancer on family dynamics and mental health. Subthemes illustrated that language and rurality may contribute to health disparities. CBO support impacted families by serving as a safety-net, fostering community, and facilitating H/L families' communication. CONCLUSIONS Childhood cancer has long-lasting effects on families, and those with non-English language preference face additional burdens. Community-based support buffers some of the negative effects of childhood cancer and may reduce disparities.
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Affiliation(s)
- Stephanie M Smith
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anmol Teer
- UC Berkeley School of Public Health, Berkeley, California, USA
| | | | - Elle Billman
- Stanford University School of Medicine, Stanford, California, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anju Goyal
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Emily M Pang
- Stanford University School of Medicine, Stanford, California, USA
| | - Caroline Pecos-Duarte
- Stanford University School of Medicine, Stanford, California, USA
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca Lewinsohn
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Smith
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Heidi Boynton
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Sandy Montes
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Esmeralda Rivera
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Daniela Ramirez
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford, California, USA
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, California, USA
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Loehrer AP, Green SR, Winkfield KM. Inequity in Cancer and Cancer Care Delivery in the United States. Hematol Oncol Clin North Am 2024; 38:1-12. [PMID: 37673697 PMCID: PMC10840640 DOI: 10.1016/j.hoc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Inequity exists along the continuum of cancer and cancer care delivery in the United States. Marginalized populations have later stage cancer at diagnosis, decreased likelihood of receiving cancer-directed care, and worse outcomes from treatment. These inequities are driven by historical, structural, systemic, interpersonal, and internalized factors that influence cancer across the pathologic and clinical continuum. To ensure equity in cancer care, interventions are needed at the level of policy, care delivery, interpersonal communication, diversity within the clinical workforce, and clinical trial accessibility and design.
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Affiliation(s)
- Andrew P Loehrer
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA; Dartmouth Cancer Center, Lebanon, NH, USA.
| | - Sybil R Green
- American Society of Clinical Oncology, 2318 Mill Road, Suite 800, Alexandria, VA 22314, USA
| | - Karen M Winkfield
- Vanderbilt University Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN 37232, USA; Meharry-Vanderbilt Alliance, 1005 Dr DB Todd Jr Boulevard, Nashville, TN 37208, USA
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Dotan E, Lynch SM, Ryan JC, Mitchell EP. Disparities in care of older adults of color with cancer: A narrative review. Cancer Med 2024; 13:e6790. [PMID: 38234214 PMCID: PMC10905558 DOI: 10.1002/cam4.6790] [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: 08/04/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race.
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Affiliation(s)
- Efrat Dotan
- Department of Hematology/OncologyFox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | | | | | - Edith P. Mitchell
- Clinical Professor of Medicine and Medical OncologySidney Kimmel Cancer Center at JeffersonPhiladelphiaPennsylvaniaUSA
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Dignan M, Cina K, Sargent M, O'Connor M, Tobacco R, Burhansstipanov L, Ahamed S, White D, Petereit D. Increasing Lung Cancer Screening for High-Risk Smokers in a Frontier Population. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:27-32. [PMID: 37688691 DOI: 10.1007/s13187-023-02369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
Northern Plains American Indians (AIs) have some of the highest smoking and lung cancer mortality rates in the USA. They are a high-risk population in which many are eligible for low-dose computed tomography (LDCT) screening, but such screening is rarely used. This study investigated methods to increase LDCT utilization through both a provider and community intervention to lower lung cancer mortality rates. This study used the Precaution Adoption Model for provider and community interventions implemented in four study regions in western South Dakota. The goal was to increase LDCT screening for eligible participants. Intake surveys and LDCT screenings were compared at baseline and 6 months following the education programs for both interventions. A total of 131 providers participated in the provider intervention. At the 6-month follow-up survey, 31 (63%) referred at least one patient for LDCT (p < 0.05). Forty (32.3%) community participants reported their provider recommended an LDCT and of those, 30(75%) reported getting an LDCT (p < 0.05). A total of 2829 patient surveys were completed at the imaging sites and most (88%, n = 962) cited provider recommendation as their reason for obtaining an LDCT. Almost half (46%; n = 131) of the referring providers attended a provider education workshop, and 73% of the providers worked at a clinic that hosted at least one community education session. Over the study period, LDCT utilization increased from 640 to 1706, a 90.9% increase. The provider intervention had the strongest impact on LDCT utilization. This study demonstrated increased LDCT utilization through the provider intervention but increases also were documented for the other intervention combinations. The community-based education program increased both community and provider awareness on the value of LDCTs to lower lung cancer mortality rates.
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Affiliation(s)
- Mark Dignan
- University of Kentucky, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA.
| | - Kristin Cina
- Avera Research Institute, Rapid City, SD, 57701, USA
| | | | | | | | | | - Sheikh Ahamed
- Ubicomp Lab, Marquette University, Milwaukee, WI, 53201, USA
| | - David White
- Dakota Radiology, Rapid City, SD, 57701, USA
| | - Daniel Petereit
- Avera Research Institute, Rapid City, SD, 57701, USA
- Monument Health Cancer Care Institute, Rapid City, SD, 57701, USA
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Congedo MT, West EC, Evangelista J, Mattingly AA, Calabrese G, Sassorossi C, Nocera A, Chiappetta M, Flamini S, Abenavoli L, Margaritora S, Boccuto L, Lococo F. The genetic susceptibility in the development of malignant pleural mesothelioma: somatic and germline variants, clinicopathological features and implication in practical medical/surgical care: a narrative review. J Thorac Dis 2024; 16:671-687. [PMID: 38410609 PMCID: PMC10894363 DOI: 10.21037/jtd-23-611] [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: 04/11/2023] [Accepted: 08/18/2023] [Indexed: 02/28/2024]
Abstract
Background and Objective Malignant pleural mesothelioma (MPM) is a very aggressive primary tumor of the pleura whose main risk factor is exposure to asbestos. However, only a minority of exposed people develops MPM and the incidence of MPM cases without an apparent association with asbestos exposure has been increasing in recent years, suggesting that genetic predisposing factors may play a crucial role. In addition, several studies reported familial cases of MPM, suggesting that heredity may be an important and underestimated feature in MPM development. Several candidate genes have been associated with a predisposition to MPM and most of them play a role in DNA repair mechanisms: overall, approximately 20% of MPM cases may be related to genetic predisposition. A particular category of patients with high susceptibility to MPM is represented by carriers of pathogenic variants in the BAP1 gene. Germline variants in BAP1 predispose to the development of MPM following an autosomal dominant pattern of inheritance in the familial cases. MPMs in these patients are significantly less aggressive, and patients require a multidisciplinary approach that involves genetic counseling, medical genetics, pathology, surgical, medical, and radiation oncology expertise. In the present narrative review, we presented a comprehensive overview of genetic susceptibility in the development of MPM. Methods The narrative review is based on a selective literature carried out in PubMed in 2023. Inclusion criteria were original articles in English language, and clinical trials (randomized, prospective, or retrospective). Key Content and Findings We summarized the somatic and germline variants and the differences in terms of clinicopathological features and prognosis between gene-related MPM (GR-MPM) and asbestos-related MPM (AR-MPM). We also discussed the indications for screening, genetic testing, and surveillance of patients with BAP1 germline variants. Conclusions In this narrative review, we have emphasized that the BAP1 gene's harmful germline variations are inherited in an autosomal dominant manner in familial cases. MPMs in individuals with these variations are less severe, and their medical care necessitates a collaborative effort. Additionally, we have outlined the current therapeutic prospects for MPM, including the possibility of gene-specific therapy, which is currently promising but still requires clinical validation.
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Affiliation(s)
| | - Elizabeth Casey West
- Healthcare Genetics and Genomics, School of Nursing, Clemson University, Clemson, SC, USA
| | - Jessica Evangelista
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Aubrey Anne Mattingly
- Healthcare Genetics and Genomics, School of Nursing, Clemson University, Clemson, SC, USA
| | - Giuseppe Calabrese
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Carolina Sassorossi
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Adriana Nocera
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Marco Chiappetta
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Sara Flamini
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, “Magna Græcia” University, Catanzaro, Italy
| | - Stefano Margaritora
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Boccuto
- Healthcare Genetics and Genomics, School of Nursing, Clemson University, Clemson, SC, USA
| | - Filippo Lococo
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
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Arya S, Mozessohn L, Gong I, Faught N, Liu N, Singh S, Chan K, Cheung MC. The impact of marginalization on diffuse large B-cell lymphoma overall survival: a retrospective cohort study. Leuk Lymphoma 2024:1-9. [PMID: 38265355 DOI: 10.1080/10428194.2024.2306463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
The aim of this study was to describe the impact of marginalization on DLBCL overall survival (OS) within the Canadian setting. We conducted a population-based retrospective cohort study of adult patients with newly diagnosed DLBCL in Ontario between 1 January 2005 and 31 December 2017 receiving a rituximab-containing chemotherapy regimen with curative intent followed until 1 March 2020. Our primary exposure of interest was the Ontario Marginalization Index (ON-Marg). The primary outcome was 2-year OS, accounting for patient age, sex, cancer characteristics, comorbidity burden, and rural dwelling status. While two-year overall survival was inferior for individuals in the most deprived marginalization quintile (70.4% Q5 vs. 76.0% Q1), after adjustment for relevant covariates neither the composite ON-Marg nor any of its dimensions had a significant effect. Within the Canadian context, among patients who receive chemotherapy, marginalization may not have a significant association with overall survival when accounting for key patient covariates, lending support for preserved outcomes.
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Affiliation(s)
- Sumedha Arya
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Inna Gong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Simron Singh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Kelvin Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Vinette B, Tock WL, Sant'Ana RSE, Cassivi C, Lemonde M, Maheu C. Advancing linguistic and epistemic equity for sex, gender and diversity in oncology care research: Moving forward and together as a community. Can Oncol Nurs J 2024; 34:79-81. [PMID: 38352932 PMCID: PMC10861236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Affiliation(s)
- Billy Vinette
- Faculty of Nursing, University of Montreal, Montreal, Canada. Research center of the Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC,
| | - Wing Lam Tock
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC,
| | | | - Christine Cassivi
- Faculty of Nursing, University of Montreal, Montreal, Canada. The Centre for Public Health Research (CReSP), Montreal, QC,
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON,
| | - Christine Maheu
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, McGill University Health Centre, Montreal, Canada,
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Khurshid H, Ismaila N, Bian J, Dabney R, Das M, Ellis P, Feldman J, Hann C, Kulkarni S, Laskin J, Manochakian R, Mishra DR, Preeshagul I, Reddy P, Saxena A, Weinberg F, Kalemkerian GP. Systemic Therapy for Small-Cell Lung Cancer: ASCO-Ontario Health (Cancer Care Ontario) Guideline. J Clin Oncol 2023; 41:5448-5472. [PMID: 37820295 DOI: 10.1200/jco.23.01435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians on the management of patients with small-cell lung cancer. METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2022. Outcomes of interest included response rates, overall survival, disease-free survival or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 95 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address systemic therapy options, timing of therapy, treatment in patients who are older or with poor performance status, role of biomarkers, and use of myeloid-supporting agents in patients with small-cell lung cancer.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | | | | | - Peter Ellis
- Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jill Feldman
- EGFR Resisters Patient Advocacy Group, Deerfield, IL
| | | | - Swati Kulkarni
- Western University, Windsor Regional Cancer Program, Windsor, Ontario, Canada
| | - Janessa Laskin
- University of British Columbia, Vancouver, British Columbia, Canada
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Anbari AB, Sandheinrich T, Hulett J, Salerno E. Understanding advanced practice registered nurse perspectives on providing care to people with a history of breast cancer. J Am Assoc Nurse Pract 2023; 35:804-812. [PMID: 37560998 DOI: 10.1097/jxx.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/23/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND People with a history of breast cancer (PHBC) face a lifelong risk of treatment-related sequelae affecting their quality of life. Stakeholders advocate for improving breast cancer survivorship outcomes by increasing clinicians' knowledge of cancer survivorship issues. In Missouri, advanced practice registered nurses (APRNs) in nononcology settings provide routine survivorship care to PHBC; however, little is known about how they approach survivorship care planning for PHBC. PURPOSE Examine perspectives of Missouri APRNs practicing in nononcology settings about providing survivorship care to PHBC. METHODS A combination of grounded theory and thematic analysis techniques was used for focus groups and semistructured interviews. The interviews were audio-recorded, transcribed, and analyzed using grounded theory coding methods. RESULTS Nineteen nononcology Missouri-based APRNs (18 NPs, 1 CNS/DNP) shared their perspectives about managing care for PHBC. We identified four major themes. Our participants (1) attuned their baseline assessment techniques to a history of breast cancer; (2) were prepared to order additional evaluations; (3) were willing to proactively figure out next best steps for PHBC beyond theneed for breast cancer recurrence surveillance; and (4) suggest that streamlining cancer survivorship care resources would benefit both clinicians and PHBC. CONCLUSIONS Our findings shed light on how APRNs approach care planning for PHBC and the needs of nononcology APRNs for managing PHBC. IMPLICATIONS FOR PRACTICE Advanced practice registered nurses are well-positioned to improve cancer survivorship care. Increasing knowledge of cancer survivorship care guidelines could improve long-term health outcomes of PHBC. Access to cancer survivorship resources or experts via telehealth/technology for both APRNs and patients could improve survivorship care and overall health of PHBC.
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Affiliation(s)
- Allison B Anbari
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | | | - Jennifer Hulett
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Elizabeth Salerno
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Rahimi S, Ononogbu O, Mohan A, Moussa D, Abughosh S, Trivedi MV. Adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic. Int J Clin Pharm 2023; 45:1396-1404. [PMID: 37380914 PMCID: PMC10682303 DOI: 10.1007/s11096-023-01609-6] [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: 12/14/2022] [Accepted: 05/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Adherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in the prevention and treatment of hormone receptor-positive (HR +) breast cancer (BC). Medication use behavior is suboptimal especially in racial/ethnic minorities with lower socioeconomic status (SES). AIM We aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on OET adherence and identify demographic and/or clinical characteristics associated with nonadherence in racial/ethnic minorities with lower SES. METHOD A retrospective study was conducted at the Harris Health System in Houston, Texas. Data were collected during the 6 months before and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. A multivariable logistic regression model was used to identify demographic/clinical characteristics associated with nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included. RESULTS In 258 patients, adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The demographic/clinical characteristics associated with OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent. CONCLUSION OET adherence was significantly reduced during the COVID-19 pandemic in racial/ethnic minority patients with low SES. Patient-centered interventions are necessary to improve OET adherence in these patients.
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Affiliation(s)
- Sama Rahimi
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Onyebuchi Ononogbu
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Anjana Mohan
- Department of Pharmaceutical Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Daniel Moussa
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Susan Abughosh
- Department of Pharmaceutical Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Meghana V Trivedi
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA.
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Miranda-Galvis M, Tjioe KC, Balas EA, Agrawal G, Cortes JE. Disparities in survival of hematologic malignancies in the context of social determinants of health: a systematic review. Blood Adv 2023; 7:6466-6491. [PMID: 37639318 PMCID: PMC10632659 DOI: 10.1182/bloodadvances.2023010690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/22/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
Social determinants of health (SDHs) have been reported as relevant factors responsible for health inequity. We sought to assess clinical data from observational studies conducted in the United States evaluating the impact of SDHs on the outcomes of patients with hematologic malignancies. Thus, we performed a systematic review in 6 databases on 1 September 2021, in which paired reviewers independently screened studies and included data from 41 studies. We assessed the risk of bias using the Joanna Briggs Institute appraisal tools and analyzed the data using a descriptive synthesis. The most common SDH domains explored were health care access and quality (54.3%) and economic stability (25.6%); others investigated were education (19%) and social and community context (7.8%). We identified strong evidence of 5 variables significantly affecting survival: lack of health insurance coverage or having Medicare or Medicaid insurance, receiving cancer treatment at a nonacademic facility, low household income, low education level, and being unmarried. In contrast, the reports on the effect of distance traveled to the treatment center are contradictory. Other SDHs examined were facility volume, provider expertise, poverty, and employment rates. We identified a lack of data in the literature in terms of transportation, debt, higher education, diet, social integration, environmental factors, or stress. Our results underscore the complex nature of social, financial, and health care barriers as intercorrelated variables. Therefore, the management of hematologic malignancies needs concerted efforts to incorporate SDHs into clinical care, research, and public health policies, identifying and addressing the barriers at a patient-based level to enhance outcome equity (PROSPERO CRD42022346854).
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Affiliation(s)
| | | | - E. Andrew Balas
- Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Gagan Agrawal
- School of Computing, University of Georgia, Athens, GA
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Del Rivero J, Perez K, Kennedy EB, Mittra ES, Vijayvergia N, Arshad J, Basu S, Chauhan A, Dasari AN, Bellizzi AM, Gangi A, Grady E, Howe JR, Ivanidze J, Lewis M, Mailman J, Raj N, Soares HP, Soulen MC, White SB, Chan JA, Kunz PL, Singh S, Halfdanarson TR, Strosberg JR, Bergsland EK. Systemic Therapy for Tumor Control in Metastatic Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline. J Clin Oncol 2023; 41:5049-5067. [PMID: 37774329 DOI: 10.1200/jco.23.01529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To develop recommendations for systemic therapy for well-differentiated grade 1 (G1) to grade 3 (G3) metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs). METHODS ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eight randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS Somatostatin analogs (SSAs) are recommended as first-line systemic therapy for most patients with G1-grade 2 (G2) metastatic well-differentiated GI-NETs. Observation is an option for patients with low-volume or slow-growing disease without symptoms. After progression on SSAs, peptide receptor radionuclide therapy (PRRT) is recommended as systematic therapy for patients with somatostatin receptor (SSTR)-positive tumors. Everolimus is an alternative second-line therapy, particularly in nonfunctioning NETs and patients with SSTR-negative tumors. SSAs are standard first-line therapy for SSTR-positive pancreatic (pan)NETs. Rarely, observation may be appropriate for asymptomatic patients until progression. Second-line systemic options for panNETs include PRRT (for SSTR-positive tumors), cytotoxic chemotherapy, everolimus, or sunitinib. For SSTR-negative tumors, first-line therapy options are chemotherapy, everolimus, or sunitinib. There are insufficient data to recommend particular sequencing of therapies. Patients with G1-G2 high-volume disease, relatively high Ki-67 index, and/or symptoms related to tumor growth may benefit from early cytotoxic chemotherapy. For G3 GEP-NETs, systemic options for G1-G2 may be considered, although cytotoxic chemotherapy is likely the most effective option for patients with tumor-related symptoms, and SSAs are relatively ineffective. Qualifying statements are provided to assist with treatment choice. Multidisciplinary team management is recommended, along with shared decision making with patients, incorporating their values and preferences, potential benefits and harms, and other characteristics and circumstances, such as comorbidities, performance status, geographic location, and access to care.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | - Sandip Basu
- Bhabha Atomic Research Centre, Tata Memorial Hospital, Mumbai, India
| | | | | | | | | | | | | | | | | | | | - Nitya Raj
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Simron Singh
- Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Hogan TH, O'Rourke BP, Weeks E, Silvera GA, Choi S. Top-level leaders and implementation strategies to support organizational diversity, equity, inclusion, and belonging (DEIB) interventions: a qualitative study of top-level DEIB leaders in healthcare organizations. Implement Sci 2023; 18:59. [PMID: 37936190 PMCID: PMC10631201 DOI: 10.1186/s13012-023-01319-7] [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: 01/27/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The Black Lives Matter movement and COVID-19 pandemic motivated the wide-scale adoption of diversity, equity, inclusion, and belonging (DEIB) initiatives within healthcare organizations and the creation of DEIB top-level leader positions. The next step is to understand how these leaders contribute to the implementation of DEIB interventions, a task with notable salience due to not only the historical difficulties associated with DEIB strategy execution, but also the substantial evidence that leadership plays a significant role in implementation processes. Therefore, the objective of this qualitative study is to understand the role of top-level DEIB leaders in the implementation of healthcare organizational DEIB interventions. METHODS A qualitative research approach which used an in-depth semi-structured interview approach was employed. We conducted thirty-one 60-90-min semi-structured interviews with DEIB top-level leaders between February 2022 and October 2022 over Zoom. An iterative coding process was used to identify the key implementation strategies and activities of DEIB top-level leaders. RESULTS Interviewees were mostly Black, majority female, and mostly heterosexual and had a variety of educational backgrounds. We identified the DEIB top-level leader as the DEIB strategy implementation champion. These leaders drive five DEIB implementation strategies: (1) People, (2) Health Equity, (3) Monitoring and Feedback, (4) Operational Planning and Communication, and (5) External Partners. Within these, we identified 19 significant activities that describe the unique implementation strategies supported by the DEIB top-level leaders. CONCLUSIONS To move toward sustained commitment to DEIB, the organization must focus on not only establishing DEIB interventions, but on their successful implementation. Our findings help explicate the implementation activities that drive the DEIB initiatives of healthcare organizations and the role of DEIB leaders. Our work can help healthcare organizations systematically identify how to support the success of DEIB organizational interventions.
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Affiliation(s)
- Tory H Hogan
- The Division of Health Services Management and Policy, The College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA.
| | - Brian P O'Rourke
- The Division of Health Services Management and Policy, The College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Eddie Weeks
- The Division of Health Services Management and Policy, The College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA
| | - Geoffrey A Silvera
- The Department of Health Services Administration, The School of Health Professions, The University of Alabama at Birmingham, School of Health Professions Bldg., 1716 9th Avenue South, Birmingham, AL, 35233, USA
| | - Seongwon Choi
- The Department of Management, The College of Business and Economics, California State University, Los Angeles, 5154 University Dr, Los Angeles, CA, 90032, USA
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Weiler-Wichtl LJ, Fohn-Erhold V, Schneider C, Schwarzinger A, Krottendorfer K, Pletschko T, Rosenmayr V, Gojo J, Peyrl A, Dieckmann K, Kollmann AS, Hansl R, Slavc I, Fries J, Hopfgartner M, Leiss U. Bridging the gap: A quality improvement project to implement psychosocial care standards into clinical practice in pediatric oncology. KLINISCHE PADIATRIE 2023; 235:350-359. [PMID: 37494589 PMCID: PMC10635755 DOI: 10.1055/a-2104-1049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Psychosocial guidelines and standards systematically describe stressors and resources in particularly challenging situations and hence serve as a basis for interventions to achieve defined psychosocial goals. Despite fundamental principles and guidelines for psychosocial methods, the quality of provided care varies considerably depending on setting, provision, and profession. The purpose of the present protocol is to illustrate the development and evaluation of the standardized psychological intervention "My Logbook", a practical guide accompanying children through all stages of treatment by directly translating current quality standards of psychosocial care into practice. METHODS In an evidence-based set-up, using face-to-face discussions and telephone conferences, a multi-professional team of local experts decide on critical disease-related issues, structure, content (information and intervention elements) and design of the quality improvement tool. Via delphi surveys an extended expert team is asked to rate the content, method, and design of all booklets which is concluded by a final agreement by the specialist group for quality assurance of the psychosocial working group in the Society for Pediatric Oncology (PSAPOH). The developed tools are piloted in an international multicenter study to evaluate the patient-reported outcome and feasibility and to integrate practical views of patients, as well as psychosocial and interdisciplinary professionals into the further development of the "My Logbook". DISCUSSION The iterative development of the "My Logbook" including local and international experts as well as the patient and practical perspective allow for the design of a process-oriented, consensus - and evidence-based tool directly translating the S3-Guideline into clinical practice. Feasibility and applicability are fostered through an iterative process of constant evaluation and adaptation of the tool by international experts and through the clinical experience gathered in the multi-centered pilot study. Furthermore, the systematic evaluation of the tool by patients, psychosocial, and interdisciplinary professionals enables the identification of persisting gaps between evidence-based standards and clinical practice, discrepancies between the various stakeholders' perspectives as well as regional differences in feasibility, thereby directly linking practice and research. The preliminary results emphasize that psychological support can be standardized, enabling an evaluation and optimization of psychosocial care which future studies need to assess in multicenter clinical randomized controlled trials.
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Affiliation(s)
- Liesa J. Weiler-Wichtl
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Verena Fohn-Erhold
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Carina Schneider
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
- Childhood Cancer International – Europe (CCI-E), Vienna,
Austria
| | | | - Kerstin Krottendorfer
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Thomas Pletschko
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Verena Rosenmayr
- Department of Pediatrics and Adolescent Medicine, General Hospital of
Vienna, Vienna, Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department for Radiooncology, Medical University of Vienna, Vienna,
Austria
| | - Alina Stefanie Kollmann
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
- Kepler Universitätsklinikum, Universitätsklinik
für Kinder- und Jugendheilkunde, Med Campus IV, Onkologie
| | - Rita Hansl
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Jonathan Fries
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
- Institute of Psychology of Development and Education, Faculty of
Psychology, University of Vienna, Vienna, Austria
| | - Maximilian Hopfgartner
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Ulrike Leiss
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center
for Pediatrics, Medical University of Vienna, Vienna, Austria
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Harmon C, Fowler M, Giri S, Tucker A, Al-Obaidi M, Rocque G, Zubkoff L, Rogers LQ, Wildes TM, Pergolotti M, Outlaw D, Shelby E, El-Rayes B, Akce M, Bhatia S, Williams GR. Implementation of the Web-Enabled Cancer & Aging Resilience Evaluation (WeCARE) in an outpatient oncology setting. J Geriatr Oncol 2023; 14:101644. [PMID: 37806291 PMCID: PMC10895518 DOI: 10.1016/j.jgo.2023.101644] [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: 06/20/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Although geriatric assessments (GAs) are recommended for use in older adults with cancer, their integration into oncology practice remain suboptimal. Here, we report our experience integrating web-enabled GA (WeCARE) into oncology practice as an augmented delivery method and provider interface format to overcome implementation barriers. MATERIALS AND METHODS Older patients (≥60 years) with a gastro-intestinal (GI) malignancy presenting for an initial visit to medical oncology clinic at a single institution between December 7, 2021 and October 10, 2022 were contacted by staff two days in advance of their visits and sent a link to the WeCARE GA, rather than the paper version used previously. Results were directly embedded into the medical record. We describe our initial implementation outcomes and the results of a provider usability survey. RESULTS Of 266 eligible patients, 221 (83.1%) were successfully contacted by telephone and 200 (75.2%) completed the WeCARE prior to their appointment. More than one phone call was required to make contact for 35.7% of patients, with a mean duration of phone conversation of 2.8 min. Most patients preferred email delivery to text (63% vs 31%); 4.5% were unable to access surveys due to inadequate technology, and 25.7% brought up additional logistical concerns. Among GI oncology providers surveyed, all six found the WeCARE tool and dashboard acceptable, appropriate, and feasible. However, only a third of providers often or always used the dashboard to inform treatment decisions and guide interventions. DISCUSSION With nearly three-quarters of patients completing the WeCARE prior to their visits with minimal staff support and time required, this method of administration may be a viable format to overcome barriers to GA implementation. Additional work is needed to integrate the results meaningfully into clinical practice.
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Affiliation(s)
- Christian Harmon
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mackenzie Fowler
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abigail Tucker
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle Rocque
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisa Zubkoff
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Q Rogers
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA
| | | | - Darryl Outlaw
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily Shelby
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bassel El-Rayes
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mehmet Akce
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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Mapanga W, Ayeni OA, Chen WC, Jacobson JS, Neugut AI, Ruff P, Cubasch H, O’Neil DS, Buccimazza I, Čačala S, Stopforth LW, Farrow HA, Nietz S, Phakathi B, Chirwa T, McCormack VA, Joffe M. The South African breast cancer and HIV outcomes study: Profiling the cancer centres and cohort characteristics, diagnostic pathways, and treatment approaches. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002432. [PMID: 37874786 PMCID: PMC10597516 DOI: 10.1371/journal.pgph.0002432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/31/2023] [Indexed: 10/26/2023]
Abstract
The South African Breast Cancer and HIV Outcomes prospective cohort (SABCHO) study was established to investigate survival determinants among HIV-positive and HIV-negative SA women with breast cancer. This paper describes common and unique characteristics of the cancer centres and their participants, examining disparities in pathways to diagnosis, treatment resources and approaches adopted to mitigate resource constraints. The Johannesburg (Jhb), Soweto (Sow), and Durban (Dbn) sites treat mainly urban, relatively better educated and more socioeconomically advantaged patients whereas the Pietermaritzburg (Pmb) and Empangeni (Emp) sites treat predominantly rural, less educated and more impoverished communities The Sow, Jhb, and Emp sites had relatively younger patients (mean ages 54 ±14.5, 55±13.7 and 54±14.3 respectively), whereas patients at the Dbn and Pmb sites, with greater representation of Asian Indian women, were relatively older (mean age 57 ±13.9 and 58 ±14.6 respectively). HIV prevalence among the cohort was high, ranging from 15%-42%, (Cohort obesity (BMI ≥ 30 kg/m2) at 60%, self-reported hypertension (41%) and diabetes (13%). Direct referral of patients from primary care clinics to cancer centre occurred only at the Sow site which uniquely ran an open clinic and where early stage (I and II) proportions were highest at 48.5%. The other sites relied on indirect patient referral from regional hospitals where significant delays in diagnostics occurred and early-stage proportions were a low (15%- 37.3%). The Emp site referred patients for all treatments to the Dbn site located 200km away; the Sow site provided surgery and endocrine treatment services but referred patients to the Jhb site 30 Km away for chemo- and radiation therapy. The Jhb, Dbn and Pmb sites all provided complete oncology treatment services. All treatment centres followed international guidelines for their treatment approaches. Findings may inform policy interventions to address national and regional disparities in breast cancer care.
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Affiliation(s)
- Witness Mapanga
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, DSI-NRF Centre of Excellence in Human Development, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Medicine, Division of Medical Oncology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Oluwatosin A. Ayeni
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Radiation Oncology, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong Carl Chen
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith S. Jacobson
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Paul Ruff
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Medicine, Division of Medical Oncology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Herbert Cubasch
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel S. O’Neil
- Yale Cancer Center and Department of Medicine, Yale University, New Haven, CT, United States of America
| | - Ines Buccimazza
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Sharon Čačala
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Laura W. Stopforth
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Hayley A. Farrow
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Sarah Nietz
- Faculty of Health Sciences, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
- Charlotte Maxeke Surgical Breast Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Boitumelo Phakathi
- Charlotte Maxeke Surgical Breast Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Surgery, School of Clinical Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Tobias Chirwa
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Valerie A. McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Maureen Joffe
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
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Bell S, Bergeron R, Murray PJ, Gazaway S, Hagan Thomas T. Describing Self-Advocacy in Underrepresented Women With Advanced Cancer. Oncol Nurs Forum 2023; 50:725-734. [PMID: 37874756 PMCID: PMC11195808 DOI: 10.1188/23.onf.725-734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
PURPOSE To describe the self-advocacy experiences of women from underrepresented groups who have advanced breast or gynecologic cancer. PARTICIPANTS & SETTING To be eligible for the study, participants had to self-identify as vulnerable, which was defined as a member of a group considered at risk for poor cancer outcomes and underrepresented in clinical research. METHODOLOGIC APPROACH This descriptive, longitudinal, qualitative study consisted of one-on-one interviews of women within three months of an advanced breast or gynecologic cancer diagnosis. FINDINGS 10 participants completed 25 interviews. The average age of participants was 60.2 years (range = 38-75 years). Three major themes emerged: (a) speaking up and speaking out, (b) interacting with the healthcare team, and (c) relying on support from others. IMPLICATIONS FOR NURSING Women with advanced cancer who are from underrepresented groups self-advocated in unique ways, learning over time the importance of how to communicate their needs and manage their healthcare team. Future research should incorporate these findings into tailored self-advocacy interventions.
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Affiliation(s)
- Sarah Bell
- University of Pittsburgh Medical Center Magee-Womens Hospital
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Gamble C, Woodard TJ, Yakubu AI, Chapman-Davis E. An Intervention-Based Approach to Achieve Racial Equity in Gynecologic Oncology. Obstet Gynecol 2023; 142:957-966. [PMID: 37678907 PMCID: PMC10510810 DOI: 10.1097/aog.0000000000005348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023]
Abstract
Racial inequities within gynecologic oncology exist at every step of the cancer continuum. Although the disparities have been well described, there is a significant gap in the literature focused on eliminating inequities in gynecologic cancer outcomes. The goal of this narrative review is to highlight successful, evidence-based interventions from within and outside of gynecologic oncology that alleviate disparity, providing a call to action for further research and implementation efforts within the field. These solutions are organized in the socioecologic framework, where multiple levels of influence-societal, community, organizational, interpersonal, and individual-affect health outcomes.
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Affiliation(s)
- Charlotte Gamble
- Division of Gynecologic Oncology, MedStar Washington Hospital Center, and Georgetown University, Washington, DC; the Division of Gynecologic Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri; the Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia; and the Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
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Carlson LE, Ismaila N, Addington EL, Asher GN, Atreya C, Balneaves LG, Bradt J, Fuller-Shavel N, Goodman J, Hoffman CJ, Huston A, Mehta A, Paller CJ, Richardson K, Seely D, Siwik CJ, Temel JS, Rowland JH. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2023; 41:4562-4591. [PMID: 37582238 DOI: 10.1200/jco.23.00857] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/13/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations. RESULTS The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline. RECOMMENDATIONS Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment. DISCUSSION Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Gary N Asher
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Chloe Atreya
- University of California San Francisco, San Francisco, CA
| | | | - Joke Bradt
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA
| | | | | | | | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY
| | | | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center, John Hopkins University, Baltimore, MD
| | | | - Dugald Seely
- University of Ottawa, Ottawa, ON, Canada
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Chelsea J Siwik
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Hirschey R, Xu J, Ericson K, Burse NR, Bankole AO, Conklin JL, Bryant AL. A Systematic Review of Interpersonal Interactions Related to Racism in Studies Assessing Breast and Gynecological Cancer Health Outcomes Among Black Women. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01769-1. [PMID: 37672189 PMCID: PMC10915105 DOI: 10.1007/s40615-023-01769-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/27/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To identify how studies measure racism-related variables at the interpersonal level and identify associated breast and gynecological cancer disparities among Black women. METHODS A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Searches were conducted in PubMed, CINAHL Plus, and Scopus using terms centered on racism and cancer. Inclusion criteria consisted of the study being conducted in the USA with Black or African American women and the study stating an outcome or focus identified as a breast or gynecological cancer health disparity. Two researchers independently screened titles and abstracts and full texts articles and completed quality assessments of included studies. Data were extracted into a matrix table, and common concepts were identified and synthesized using the matrix method. The quality of included studies was assessed using the Joanna Briggs Institute's critical appraisal tools. RESULTS Thirteen studies that examined the effect of racism-related variables operating at the interpersonal level on breast, cervical, and ovarian cancer outcomes in Black women were identified for inclusion. Across studies, racism-related variables were measured as discrimination, trust, racism, and clinician-patient interactions. Additionally, across studies, disparities were identified in cancer screening, treatment received, survivorship quality of life, and incidence. CONCLUSION This review highlights the need for valid, reliable, and consistent measurement of racism operating at the interpersonal level to first understand its impact on cancer health disparities and to also facilitate the development and evaluation of interventions aimed at mitigating interpersonal-level racism.
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Affiliation(s)
- Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jingle Xu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn Ericson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natasha Renee Burse
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jamie L Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley Leak Bryant
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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50
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Raimondo D, Raffone A, Pezzullo AM, Doglioli M, De Benedetti P, Celerino P, De Meis L, Maletta M, Raspollini A, Travaglino A, Guida M, Casadio P, Seracchioli R. Race and ethnicity reporting in endometrial cancer literature. Int J Gynecol Cancer 2023; 33:1402-1407. [PMID: 37479465 DOI: 10.1136/ijgc-2023-004552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVES There is evidence that there are differences in survival outcomes among patients with endometrial cancer of different ethnic groups. We aimed to assess the quantity and quality of race/ethnicity reporting in the literature on endometrial cancer published from January 2020 to December 2020. METHODS In this systematic review, electronic searches of PubMed, MEDLINE, Web of Sciences, Scopus, and Cochrane Library databases were performed for all articles published in 2020. A total of 3330 articles were reviewed, of which 949 (35%) peer-reviewed human-based articles focusing on endometrial cancer were included. Non-research-focused articles, review articles, meta-analyses, case reports, and non-human studies were excluded. We analyzed the proportion of studies reporting race/ethnicity and assessed the quality of reporting with regard to the adherence to the International Committee of Medical Journal Editors (ICMJE) recommendations. We evaluated the influence of study characteristics on race/ethnicity reporting and compared articles published in journals which adhere to the ICMJE recommendations against those that did not explicitly state that they did. RESULTS Of the 949 (28.5%) included articles, 166 (17.5%) reported race/ethnicity of patients, with low quality of reporting. The reporting rate of race/ethnicity was similar when comparing articles from ICMJE and non-ICMJE journals (62 (20.4%) vs 104 (16.1%); p=0.11), prospective versus retrospective studies (53 (22.7%) vs 113 (15.8%); p=0.02), and national versus international studies (147 (17.5%) vs 19 (17.4%); p=0.99). Studies performed in the WHO region of Americas were significantly more consistent in reporting race compared with other regions (119 (44.7%) vs 23 (6.8%) European, 2 (7.4%) Eastern Mediterranean, 21 (7.1%) Western Pacific, 0 (0%) South-East Asia; p<0.001). Female corresponding authors were significantly more consistent in reporting race than male authors (94 (22.5%) vs 72 (13.6%); p<0.001). CONCLUSIONS Human-based articles focusing on endometrial cancer have a low frequency and quality of race/ethnicity reporting, even in journals claiming to follow ICMJE recommendations.
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Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Angelo Maria Pezzullo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marisol Doglioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Pierandrea De Benedetti
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Pierluigi Celerino
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Lucia De Meis
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
| | - Manuela Maletta
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Arianna Raspollini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Antonio Travaglino
- Gynecopathology and Breast Pathology Unit, University Hospital Agostino Gemelli Department of Woman and Child Health Sciences, Rome, Italy
| | - Maurizio Guida
- Department of Neuroscience and Reproductive Sciences and Dentistry, University of Naples Federico II, Napoli, Campania, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
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