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Howell KE, Shaw M, Santucci AK, Rodgers K, Ortiz Rodriguez I, Taha D, Laclair S, Wolder C, Cooper C, Moon W, Vukadinovich C, Erhardt MJ, Dean SM, Armstrong GT, Ness KK, Hudson MM, Yasui Y, Huang IC. Using an mHealth approach to collect patient-generated health data for predicting adverse health outcomes among adult survivors of childhood cancer. Front Oncol 2024; 14:1374403. [PMID: 38800387 PMCID: PMC11116558 DOI: 10.3389/fonc.2024.1374403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Cancer therapies predispose childhood cancer survivors to various treatment-related late effects, which contribute to a higher symptom burden, chronic health conditions (CHCs), and premature mortality. Regular monitoring of symptoms between clinic visits is useful for timely medical consultation and interventions that can improve quality of life (QOL). The Health Share Study aims to utilize mHealth to collect patient-generated health data (PGHD; daily symptoms, momentary physical health status) and develop survivor-specific risk prediction scores for mitigating adverse health outcomes including poor QOL and emergency room admissions. These personalized risk scores will be integrated into the hospital-based electronic health record (EHR) system to facilitate clinician communications with survivors for timely management of late effects. Methods This prospective study will recruit 600 adult survivors of childhood cancer from the St. Jude Lifetime Cohort study. Data collection include 20 daily symptoms via a smartphone, objective physical health data (physical activity intensity, sleep performance, and biometric data including resting heart rate, heart rate variability, oxygen saturation, and physical stress) via a wearable activity monitor, patient-reported outcomes (poor QOL, unplanned healthcare utilization) via a smartphone, and clinically ascertained outcomes (physical performance deficits, onset of/worsening CHCs) assessed in the survivorship clinic. Participants will complete health surveys and physical/functional assessments in the clinic at baseline, 2) report daily symptoms, wear an activity monitor, measure blood pressure at home over 4 months, and 3) complete health surveys and physical/functional assessments in the clinic 1 and 2 years from the baseline. Socio-demographic and clinical data abstracted from the EHR will be included in the analysis. We will invite 20 cancer survivors to investigate suitable formats to display predicted risk information on a dashboard and 10 clinicians to suggest evidence-based risk management strategies for adverse health outcomes. Analysis Machine and statistical learning will be used in prediction modeling. Both approaches can handle a large number of predictors, including longitudinal patterns of daily symptoms/other PGHD, along with cancer treatments and socio-demographics. Conclusion The individualized risk prediction scores and added communications between providers and survivors have the potential to improve survivorship care and outcomes by identifying early clinical presentations of adverse events.
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Affiliation(s)
- Kristen E. Howell
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, United States
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Marian Shaw
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Aimee K. Santucci
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Kristy Rodgers
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Izeris Ortiz Rodriguez
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Danah Taha
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Sara Laclair
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Carol Wolder
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Christie Cooper
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Wonjong Moon
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Christopher Vukadinovich
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Matthew J. Erhardt
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Shannon M. Dean
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
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Reeves TJ, Mathis TJ, Bauer HE, Hudson MM, Robison LL, Wang Z, Baker JN, Huang IC. Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review. Front Public Health 2021; 9:741334. [PMID: 34778176 PMCID: PMC8586515 DOI: 10.3389/fpubh.2021.741334] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.
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Affiliation(s)
- Tegan J Reeves
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Taylor J Mathis
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Hailey E Bauer
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
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