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Reblin M, Ambrose N, Pastore N, Nowak S. Perceived helpfulness of caregiver support resources: Results from a state-wide poll. PEC INNOVATION 2024; 4:100295. [PMID: 38855072 PMCID: PMC11157270 DOI: 10.1016/j.pecinn.2024.100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/11/2024]
Abstract
Objective Our goal was to identify specific types of services desired by caregivers and determine subgroups most interested in each service type. Methods Caregiving questions were added to a state-wide poll conducted in a majority-rural state. Those who identified as caregivers (n = 428) were asked to report on the helpfulness of 6 domains of services. Descriptive analysis and logistic regressions were conducted. Results Top resources caregivers identified as potentially helpful included hands-on services (33.9%), help coordinating care from multiple providers (21.5%), help with finances (18.9%), and help managing emotional stress (17.8%). Only 15% indicated no caregiver resources would be helpful. Younger caregivers endorsed several service domains as more helpful than older caregivers; caregivers reporting higher stress were more likely to endorse most domains as helpful. Conclusion Data reinforces the overwhelming need to offer caregiver services. Navigation and integrated and tailored service models may be beneficial to help caregivers identify and access appropriate services within healthcare systems. Innovation This study uses an innovative approach to identifying needs of caregivers, who are often invisible within the healthcare system. Our findings suggest a paradigm shift is needed to broaden the scope and depth of services offered to caregivers.
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Affiliation(s)
- Maija Reblin
- Vermont Conversation Lab, Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Natalie Ambrose
- Vermont Conversation Lab, Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Nina Pastore
- Vermont Conversation Lab, Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Sarah Nowak
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
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Davis HA, Hoberg AA, Jacobus LS, Nepple K, Seaman AT, Sorensen J, Weiner GJ, Gilbertson-White S. Leveraging oncology collaborative networks and biomedical informatics data resources to rapidly recruit and enroll rural residents into oncology quality of life clinical trials. J Clin Transl Sci 2024; 8:e135. [PMID: 39345703 PMCID: PMC11428118 DOI: 10.1017/cts.2024.576] [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: 03/09/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 10/01/2024] Open
Abstract
Purpose This study assesses the feasibility of biomedical informatics resources for efficient recruitment of rural residents with cancer to a clinical trial of a quality-of-life (QOL) mobile app. These resources have the potential to reduce costly, time-consuming, in-person recruitment methods. Methods A cohort was identified from the electronic health record data repository and cross-referenced with patients who consented to additional research contact. Rural-urban commuting area codes were computed to identify rurality. Potential participants were emailed study details, screening questions, and an e-consent link via REDCap. Consented individuals received baseline questionnaires automatically. A sample minimum of n = 80 [n = 40 care as usual (CAU) n = 40 mobile app intervention] was needed. Results N = 1298 potential participants (n = 365 CAU; n = 833 intervention) were screened for eligibility. For CAU, 68 consented, 67 completed baseline questionnaires, and 54 completed follow-up questionnaires. For intervention, 100 consented, 97 completed baseline questionnaires, and 58 completed follow-up questionnaires. The CAU/intervention reached 82.5%/122.5% of the enrollment target within 2 days. Recruitment and retention rates were 15.3% and 57.5%, respectively. The mean age was 59.5 ± 13.5 years. The sample was 65% women, 20% racial/ethnic minority, and 35% resided in rural areas. Conclusion These results demonstrate that biomedical informatics resources can be highly effective in recruiting for cancer QOL research. Precisely identifying individuals likely to meet inclusion criteria who previously indicated interest in research participation expedited recruitment. Participants completed the consent and baseline questionnaires with zero follow-up contacts from the research team. This low-touch, repeatable process may be highly effective for multisite clinical trials research seeking to include rural residents.
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Affiliation(s)
- Heath A Davis
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Carver College of Medicine IT, University of Iowa, Iowa City, IA, USA
| | - Asher A Hoberg
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Carver College of Medicine IT, University of Iowa, Iowa City, IA, USA
| | - Laura S Jacobus
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Vanderbilt Institute for Clinical & Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth Nepple
- Urology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Aaron T Seaman
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Jamie Sorensen
- Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - George J Weiner
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Stephanie Gilbertson-White
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Community & Primary Care, College of Nursing, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
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Tadé Y, Timperley J, Dilsaver D, McDermott J, de Rosa N, Al-Refaie WB. High-risk rural surgical patients and poor access to elective colorectal cancer surgery: insight for multilevel intervention for rural America. J Gastrointest Surg 2024:S1091-255X(24)00583-3. [PMID: 39242216 DOI: 10.1016/j.gassur.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of death in rural America. Rural populations are large and heterogeneous, yet patient-related drivers of inequities in CRC access are understudied. This study aimed to identify vulnerable rural populations at lower odds of undergoing elective CRC surgery. METHODS Evaluation of the Policy Map and United States Census Bureau identified factors associated with poor surgical access in the most populous states (by total rural population). To assess whether these identified factors were associated with reduced access to elective CRC surgery, the 2007 to 2020 National Inpatient Sample was used to evaluate 69,212 hospitalizations of rural patients undergoing CRC surgery. Rural was defined as counties with a population of <250,000. Multivariable logistic regression models assessed predictors of elective CRC surgery. Patient- and hospital-level factor interactions were specified a priori. RESULTS More than 72% of hospitalizations of rural patients were elective. Multivariate regression analysis demonstrated that older age, multimorbidity, Black race, Latino-Hispanic ethnicity, Medicaid insurance, and rural hospitals predicted lower odds of elective CRC surgery. On interaction analyses, high-risk patients were less likely to undergo elective CRC surgery in urban facilities relative to rural. CONCLUSION In this large study of rural dwellers, ethnoracial minorities, elders, and Medicaid beneficiaries had profoundly less access to elective CRC surgery, especially when care was received in urban settings. Future studies should focus on exploring actionable social drivers of health in these rural populations. Findings underscore the need for multilevel interventions to enhance rural access to equitable and quality surgical cancer care.
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Affiliation(s)
- Yanick Tadé
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, United States; Department of Surgery, Catholic Health Initiatives Health, Omaha, NE, United States
| | - Jillian Timperley
- Department of Surgery, Catholic Health Initiatives Health, Omaha, NE, United States
| | - Danielle Dilsaver
- Department of Surgery, Catholic Health Initiatives Health, Omaha, NE, United States; Department of Clinical Research and Public Helath, Creighton University School of Medicine, Omaha, NE, United States
| | - James McDermott
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Nicole de Rosa
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, United States; Department of Surgery, Catholic Health Initiatives Health, Omaha, NE, United States
| | - Waddah B Al-Refaie
- Department of Surgery, Creighton University School of Medicine, Omaha, NE, United States; Department of Surgery, Catholic Health Initiatives Health, Omaha, NE, United States.
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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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Cotner CE, O’Donnell E. Understanding the Landscape of Multi-Cancer Detection Tests: The Current Data and Clinical Considerations. Life (Basel) 2024; 14:896. [PMID: 39063649 PMCID: PMC11278188 DOI: 10.3390/life14070896] [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: 05/15/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Multi-cancer detection (MCD) tests are blood-based assays that screen for multiple cancers concurrently and offer a promising approach to improve early cancer detection and screening uptake. To date, there have been two prospective interventional studies evaluating MCD tests as a screening tool in human subjects. No MCD tests are currently approved by the FDA, but there is one commercially available MCD test. Ongoing trials continue to assess the efficacy, safety, and cost implications of MCD tests. In this review, we discuss the performance of CancerSEEK and Galleri, two leading MCD platforms, and discuss the clinical consideration for the broader application of this new technology.
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Affiliation(s)
- Cody E. Cotner
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - Elizabeth O’Donnell
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Boston, MA 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston, Boston, MA 02115, USA
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Lo CH, Tun KM, Pan CW, Lee JK, Singh H, Samadder NJ. Association Between Social Vulnerability and Gastrointestinal Cancer Mortality in the United States Counties. GASTRO HEP ADVANCES 2024; 3:821-829. [PMID: 39280915 PMCID: PMC11401585 DOI: 10.1016/j.gastha.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/19/2024] [Indexed: 09/18/2024]
Abstract
Background and Aims Social determinants of health contribute to disparities in gastrointestinal (GI) cancer mortality between individuals in the US. Their effects on count-level mortality rates remain uncertain. We aimed to assess the association between county social vulnerability and GI cancer mortality. Methods In this ecological study (2016-2020), we obtained US county Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and age-adjusted mortality rates (AAMRs) for GI cancers from Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiological Research). SVI ranges from 0 to 1, with higher indices indicating greater vulnerability. We presented AAMRs by quintiles of SVIs. We used Poisson regression through generalized estimating equation to calculate rate ratios (RRs) and 95% confidence intervals (CIs) for GI cancer mortality by quintiles of SVI. Results There were 799,968 deaths related to GI cancers from 2016 to 2020, resulting in an AAMR (95% CI) of 39.9 (41.4-51.2) deaths per 100,000 population. The largest concentration of counties with greater SVI and GI cancer mortality was clustered in the southern US. Counties with greater SVI had higher mortality related to all GI cancers (RRQ5 vs Q1, 1.19 [95% CI, 1.14-1.24]), gastric cancer (1.58 [1.48-1.69]), liver cancer (1.54 [1.36-1.73]), and colorectal cancer (RRQ5 vs Q1, 1.23 [95% CI, 1.15-1.31]). RRs for overall GI cancers were greater among individuals <45 years (1.24 [1.15-1.32]), men (1.22 [1.16-1.27]), Hispanic individuals (1.33 [1.18-1.50]), and rural counties (1.21 [1.14-1.27]) compared with their counterparts. Conclusion Socially disadvantaged counties face a disproportionately high burden of GI cancer mortality in the US. Targeted public health interventions should aim to address social inequities faced by underserved communities.
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Affiliation(s)
- Chun-Han Lo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Kyaw Min Tun
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada
| | - Chun-Wei Pan
- Cook County Health, John H. Stroger Hospital, Chicago, Illinois
| | - Jeffrey K Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Harminder Singh
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - N Jewel Samadder
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona
- Department of Clinical Genomics, Mayo Clinic, Phoenix, Arizona
- Center for Individualized Medicine, Mayo Clinic, Phoenix, Arizona
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McPhee NJ, Leach M, Nightingale CE, Harris SJ, Segelov E, Ristevski E. Differences in cancer clinical trial activity and trial characteristics at metropolitan and rural trial sites in Victoria, Australia. Aust J Rural Health 2024; 32:569-581. [PMID: 38629876 DOI: 10.1111/ajr.13102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVE Cancer clinical trials (CCTs) provide access to emerging therapies and extra clinical care. We aimed to describe the volume and characteristics of CCTs available across Victoria, Australia, and identify factors associated with rural trial location. METHODS Quantitative analysis of secondary data from Cancer Council Victoria's Clinical Trials Management Scheme dataset. DESIGN A cross-sectional study design was used. SETTING CCTs were available Victoria-wide in 2018. PARTICIPANTS There were 1669 CCTs and 5909 CCT participants. MAIN OUTCOME MEASURES Rural CCT location was assessed as a binary variable with categories of 'yes' (modified Monash [MM] categories 2-7) and 'no' (MM category 1). MM categories were determined from postcodes. The highest ('least rural') MM category was used for postcodes with multiple MM categories. RESULTS Of 1669 CCTs, 168 (10.1%) were conducted in rural areas. Of 5909 CCT participants, 315 (5.3%) participated in rural CCTs. There were 526 CCTs (31.5%) with 1907 (32.3%) newly enrolled participants. Of 1892 newly enrolled participants with postcode data, 488 (25.8%) were rural residents. Of them, 368 (75.4%) participated in metropolitan CCTs. In a multivariable logistic regression analysis for all 1669 CCTs, odds of a rural rather than metropolitan CCT location were significantly (p-value <0.05) lower for early-phase than late-phase trials and non-solid than solid tumour trials but significantly (p-value <0.05) higher for non-industry than industry-sponsored trials. CONCLUSIONS In Victoria, 10% of CCTs are at rural sites. Most rural-residing CCT participants travel to metropolitan sites, where there are more late-phase, non-solid-tumour and industry-sponsored trials. Approaches to increase the volume and variety of rural CCTs should be considered.
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Affiliation(s)
- Narelle J McPhee
- School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | - Michael Leach
- School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | - Claire E Nightingale
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samuel J Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, Victoria, Australia
| | - Eva Segelov
- Department of Clinical Research, Faculty of Medicine, University of Bern, Bern, Switzerland
- Department of Radiation Oncology, Inselspital, Bern, Switzerland
| | - Eli Ristevski
- Monash University, Monash Rural Health, Warragul, Victoria, Australia
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Scodari BT, Schaefer AP, Kapadia NS, O'Malley AJ, Brooks GA, Tosteson ANA, Onega T, Wang C, Wang F, Moen EL. Characterizing the Traveling Oncology Workforce and Its Influence on Patient Travel Burden: A Claims-Based Approach. JCO Oncol Pract 2024; 20:787-796. [PMID: 38386962 DOI: 10.1200/op.23.00690] [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] [Revised: 11/30/2023] [Accepted: 01/09/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE Oncology outreach is a common strategy for extending cancer care to rural patients. However, a nationwide characterization of the traveling workforce that enables this outreach is lacking, and the extent to which outreach reduces travel burden for rural patients is unknown. METHODS This cross-sectional study analyzed a rural (nonurban) subset of a 100% fee-for-service sample of 355,139 Medicare beneficiaries with incident breast, colorectal, and lung cancers. Surgical, medical, and radiation oncologists were linked to patients using Part B claims, and traveling oncologists were identified by observing hospital service area (HSA) transition patterns. We defined oncology outreach as the provision of cancer care by a traveling oncologist outside of their primary HSA. We used hierarchical gamma regression models to examine the separate associations between patient receipt of oncology outreach and one-way patient travel times to chemotherapy, radiotherapy, and surgery. RESULTS On average, 9,935 of 39,960 oncologists conducted annual outreach, where 57.8% traveled with low frequency (0-1 outreach visits/mo), 21.1% with medium frequency (1-3 outreach visits/mo), and 21.1% with high frequency (>3 outreach visits/mo). Oncologists provided surgery, radiotherapy, and chemotherapy to 51,715, 27,120, and 5,874 rural beneficiaries, respectively, of whom 2.5%, 6.9%, and 3.6% received oncology outreach. Rural patients who received oncology outreach traveled 16% (95% CI, 11 to 21) and 11% (95% CI, 9 to 13) less minutes to chemotherapy and radiotherapy than those who did not receive oncology outreach, corresponding to expected one-way savings of 15.9 (95% CI, 15.5 to 16.4) and 11.9 (95% CI, 11.7 to 12.2) minutes, respectively. CONCLUSION Our study introduces a novel claims-based approach for tracking the nationwide traveling oncology workforce and supports oncology outreach as an effective means for improving rural access to cancer care.
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Affiliation(s)
- Bruno T Scodari
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Andrew P Schaefer
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - A James O'Malley
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Tracy Onega
- Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Changzhen Wang
- Department of Geography and the Environment, The University of Alabama, Tuscaloosa, AL
| | - Fahui Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA
| | - Erika L Moen
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Dartmouth Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH
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Sabik LM, Kwon Y, Drake C, Yabes J, Bhattacharya M, Sun Z, Bradley CJ, Jacobs BL. Impact of the Affordable Care Act on access to accredited facilities for cancer treatment. Health Serv Res 2024. [PMID: 38698670 DOI: 10.1111/1475-6773.14315] [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: 05/05/2024] Open
Abstract
OBJECTIVE To examine differential changes in receipt of surgery at National Cancer Institute (NCI)-designated comprehensive cancer centers (NCI-CCC) and Commission on Cancer (CoC) accredited hospitals for patients with cancer more likely to be newly eligible for coverage under Affordable Care Act (ACA) insurance expansions, relative to those less likely to have been impacted by the ACA. DATA SOURCES AND STUDY SETTING Pennsylvania Cancer Registry (PCR) for 2010-2019 linked with discharge records from the Pennsylvania Health Care Cost Containment Council (PHC4). STUDY DESIGN Outcomes include whether cancer surgery was performed at an NCI-CCC or a CoC-accredited hospital. We conducted a difference-in-differences analysis, estimating linear probability models for each outcome that control for residence in a county with above median county-level pre-ACA uninsurance and the interaction between county-level baseline uninsurance and cancer treatment post-ACA to capture differential changes in access between those more and less likely to become newly eligible for insurance coverage (based on area-level proxy). All models control for age, sex, race and ethnicity, cancer site and stage, census-tract level urban/rural residence, Area Deprivation Index, and year- and county-fixed effects. DATA COLLECTION/EXTRACTION METHODS We identified adults aged 26-64 in PCR with prostate, lung, or colorectal cancer who received cancer-directed surgery and had a corresponding surgery discharge record in PHC4. PRINCIPAL FINDINGS We observe a differential increase in receiving care at an NCI-CCC of 6.2 percentage points (95% CI: 2.6-9.8; baseline mean = 9.8%) among patients in high baseline uninsurance areas (p = 0.001). Our estimate of the differential change in care at the larger set of CoC hospitals is positive (3.9 percentage points [95% CI: -0.5-8.2; baseline mean = 73.7%]) but not statistically significant (p = 0.079). CONCLUSIONS Our findings suggest that insurance expansions under the ACA were associated with increased access to NCI-CCCs.
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Affiliation(s)
- Lindsay M Sabik
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Youngmin Kwon
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Coleman Drake
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jonathan Yabes
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Zhaojun Sun
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Cathy J Bradley
- Colorado School of Public Health and University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Bruce L Jacobs
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Silvestre J, Aakhus E, Weldeslase TA, DeLisser HM. A 15-Year Analysis of Supply and Demand for Hematology and Oncology Training in the United States. JCO Oncol Pract 2024; 20:717-724. [PMID: 38285966 DOI: 10.1200/op.23.00531] [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: 08/23/2023] [Revised: 10/14/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
PURPOSE There is a paucity of research on the supply of the hematology and oncology workforce despite projected shortages in the United States Over the past 15 years of the hematology and oncology match (HOM), we hypothesized that there would be more growth in the number of training positions relative to applicants, higher match rates for US allopathic graduates relative to non-US allopathic graduates, and fewer applicants matching at their top fellowship choices. METHODS This was a national, retrospective cohort study of all applicants in the HOM (2009-2023). Match rates and applicant-to-training position ratios were calculated and compared over time with Pearson tests. RESULTS Growth in the number of annual training positions (426-708; 66% increase) exceeded growth in the number of interested applicants (706-945; 34% increase; P < .001). Annual applicant-to-training position ratios decreased from 1.7 to 1.3 (r = -0.813; P < .001). Match rates increased over the study period for both US allopathic graduates (79%-88%; r = 0.761; P = .001) and non-US allopathic graduates (45%-63%; r = 0.801; P < .001). During each year, match rates for US allopathic graduates exceeded those for non-US allopathic graduates (P < .001). From 2018 to 2023, US allopathic graduates (83%) had higher match rates than US osteopathic graduates (60%) and international medical graduates (50%; P < .001). The percentage of applicants that matched at one of their top three fellowship choices increased from 53% to 60% (r = 0.480; P = .070). Fewer available annual training positions went unfilled over the study period (3%-0.3%; r = - 0.870; P < .001). CONCLUSION Match rates have increased in the HOM but remain competitive especially for non-US allopathic graduates. Future investigation is needed to understand disparities in match outcomes by additional applicant and fellowship program characteristics. Ongoing surveillance of HOM outcomes remains critical given the projected shortages in the US hematology and oncology workforce.
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Affiliation(s)
| | - Erin Aakhus
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Horace M DeLisser
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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11
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Okado I, Liu M, Elhajj C, Hernandez BY, Wilkens L, Holcombe RF. Time to Diagnosis and Treatment Initiation During the COVID-19 Pandemic Among Rural Patients With Cancer. Asia Pac J Public Health 2024; 36:387-390. [PMID: 38553966 DOI: 10.1177/10105395241240968] [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: 10/08/2024]
Abstract
Time to diagnosis (TTD) and treatment initiation (TTI) are important measures of access to and quality of cancer care. This study addressed the knowledge gap on the impact of the COVID-19 pandemic on TTD and TTI for rural cancer patients. Sixty-three cancer patients residing in rural areas of the state of Hawaii were surveyed in 2020 to 2021. Overall, 67.5% of participants reported TTD within one month of reporting symptoms to a health care provider. Mean TTI for the overall sample was 55.3 days, and among breast cancer patients, 57.9 days. Compared with pre-pandemic state registry data, mean TTI for the overall sample and breast cancer patients were significantly longer than the state registry null value of 40 days (P = .02 and P =.05, respectively). During the COVID-19 pandemic, cancer patients in rural Hawaii experienced substantial delays in TTI compared with pre-pandemic years.
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Affiliation(s)
- Izumi Okado
- University of Hawai'i Cancer Center, Honolulu, HI, USA
| | - Michelle Liu
- University of Hawai'i Cancer Center, Honolulu, HI, USA
| | - Carry Elhajj
- University of Hawai'i Cancer Center, Honolulu, HI, USA
| | | | - Lynne Wilkens
- University of Hawai'i Cancer Center, Honolulu, HI, USA
| | - Randall F Holcombe
- University of Hawai'i Cancer Center, Honolulu, HI, USA
- University of Vermont Cancer Center, Burlington, VT, USA
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12
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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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13
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Mehtsun WT, Gupta S. Racial Disparities in Receipt of Guideline-Concordant Care for Early-Onset Colorectal Cancer: We Must Do Better. J Clin Oncol 2024; 42:1335-1339. [PMID: 38489553 PMCID: PMC11095873 DOI: 10.1200/jco.23.02186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/20/2023] [Accepted: 02/01/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Winta T. Mehtsun
- Department of Surgery, Division of Surgical Oncology, University of California San Diego, La Jolla, CA
| | - Samir Gupta
- Department of Medicine, Division of Gastroenterology, University of California San Diego, La Jolla, CA
- Department of Medicine, Section of Gastroenterology, VA San Diego Healthcare System, San Diego, CA
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14
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Loria A, Ramsdale EE, Aquina CT, Cupertino P, Mohile SG, Fleming FJ. From Clinical Trials to Practice: Anticipating and Overcoming Challenges in Implementing Watch-and-Wait for Rectal Cancer. J Clin Oncol 2024; 42:876-880. [PMID: 38315943 DOI: 10.1200/jco.23.01369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 02/07/2024] Open
Affiliation(s)
- Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Erika E Ramsdale
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Christopher T Aquina
- Departments of Colorectal Surgery and Surgical Oncology, AdventHealth Orlando, Orlando, FL
| | - Paula Cupertino
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
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15
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Choudry M, Dindinger‐Hill K, Ambrose J, Horns J, Vehawn J, Gill H, Murray NZ, Hunt TE, Martin C, Haaland B, Chipman J, Hanson HA, O'Neil BB. Urban relatives ameliorate survival disparities for genitourinary cancer in rural patients. Cancer Med 2024; 13:e7058. [PMID: 38477496 PMCID: PMC10935886 DOI: 10.1002/cam4.7058] [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: 08/28/2023] [Revised: 01/04/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Patients living in rural areas have worse cancer-specific outcomes. This study examines the effect of family-based social capital on genitourinary cancer survival. We hypothesized that rural patients with urban relatives have improved survival relative to rural patients without urban family. METHODS We examined rural and urban based Utah individuals diagnosed with genitourinary cancers between 1968 and 2018. Familial networks were determined using the Utah Population Database. Patients and relatives were classified as rural or urban based on 2010 rural-urban commuting area codes. Overall survival was analyzed using Cox proportional hazards models. RESULTS We identified 24,746 patients with genitourinary cancer with a median follow-up of 8.72 years. Rural cancer patients without an urban relative had the worst outcomes with cancer-specific survival hazard ratios (HRs) at 5 and 10 years of 1.33 (95% CI 1.10-1.62) and 1.46 (95% CI 1.24-1.73), respectively relative to urban patients. Rural patients with urban first-degree relatives had improved survival with 5- and 10-year survival HRs of 1.21 (95% CI 1.06-1.40) and 1.16 (95% CI 1.03-1.31), respectively. CONCLUSIONS Our findings suggest rural patients who have been diagnosed with a genitourinary cancer have improved survival when having relatives in urban centers relative to rural patients without urban relatives. Further research is needed to better understand the mechanisms through which having an urban family member contributes to improved cancer outcomes for rural patients. Better characterization of this affect may help inform policies to reduce urban-rural cancer disparities.
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Affiliation(s)
- Mouneeb Choudry
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
- Department of UrologyMayo ClinicPhoenixArizonaUSA
| | | | - Jacob Ambrose
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Joshua Horns
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Jeffrey Vehawn
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Hailie Gill
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Nicole Z. Murray
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Trevor E. Hunt
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
- Department of UrologyUniversity of RochesterRochesterNew YorkUSA
| | | | - Benjamin Haaland
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Jonathan Chipman
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Heidi A. Hanson
- Division of UrologyUniversity of UtahSalt Lake CityUtahUSA
- Computational Sciences and Engineering DivisionOak Ridge National LaboratoryOak RidgeTennesseeUSA
| | - Brock B. O'Neil
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
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16
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Anampa-Guzmán A, Contreras-Chavez P, Lustberg MB, Nekhlyudov L. Online description of services provided in adult survivorship programs across U.S. accredited cancer centers. J Cancer Surviv 2024; 18:79-83. [PMID: 36933086 DOI: 10.1007/s11764-023-01361-w] [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: 09/24/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The American College of Surgeons Standard 4.8 requires an institution to implement a survivorship program to become a Commission on Cancer (CoC)-accredited cancer center. The online information offered by these cancer centers can help educate patients and their caregivers about available services. We assessed the content of survivorship program websites of CoC-accredited cancer centers in the United States. METHODS Of the 1245 CoC-accredited centers for adults, we sampled 325 institutions (26%) based proportionately on the 2019 new cancer cases by state. Website pages of the institutions' survivorship programs were assessed for information and services offered using the COC Standard 4.8. We included programs for adult survivors of adult- and childhood-onset cancers. RESULTS 54.5% of the cancer centers did not have a survivorship program website. Of the 189 included programs, most were aimed at adult survivors in general, rather than those with specific cancer types. On average, five essential CoC-recommended services were described, most commonly nutrition, care plans, and psychology services. The least mentioned services were genetic counseling, fertility, and smoking cessation. Most programs described services offered to patients who had completed treatment, while 7.4% of described services for those with metastatic disease. CONCLUSION More than half of CoC-accredited programs did have information about cancer survivorship programs on their websites and when included, had variable and limited description of services. IMPLICATIONS FOR CANCER SURVIVORS Our study provides an overview of online cancer survivorship services and offers a methodology that may be used by cancer centers to review, expand, and improve the information described on their websites.
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Affiliation(s)
- Andrea Anampa-Guzmán
- San Fernando Medical SchoolFaculty of Medicine, Universidad Nacional Mayor de San Marcos. Lima, Lima, Peru.
- Department of Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm St, Buffalo, NY, 14203, USA.
| | | | | | - Larissa Nekhlyudov
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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17
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Emile SH, Horesh N, Freund MR, Silva-Alvarenga E, Garoufalia Z, Gefen R, Wexner SD. Surgical outcomes and predictors of overall survival of stage I-III appendiceal adenocarcinoma: Retrospective cohort analysis of the national cancer database. Surg Oncol 2024; 52:102034. [PMID: 38211448 DOI: 10.1016/j.suronc.2024.102034] [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: 09/04/2023] [Revised: 12/08/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND This study aimed to determine predictors of overall survival (OS) after surgical treatment of stage I-III appendiceal adenocarcinoma and compare the outcomes of partial colectomy and hemicolectomy. METHODS A retrospective analysis of the U.S. National Cancer Database (NCDB) including patients who underwent surgery for stage I-III appendiceal adenocarcinoma between 2005 and 2019 was conducted. A propensity-score matched analysis was undertaken to compare the outcomes of partial and hemicolectomy and multivariate analysis was performed to determine predictive factors of OS. The main outcome was OS and its independent predictors. RESULTS 2607 patients (51.6 % male) with a mean age of 61.6 ± 13.9 years were included. 61.7 % of patients underwent hemicolectomy while 31.7 % underwent partial colectomy. After matching, partial colectomy, and hemicolectomy had similar OS (117.3 vs 117.2 months; p = 0.08), positive resection margins, short-term mortality, and 30-day readmission. The hemicolectomy group was associated with more examined lymph nodes and longer hospital stays. Older age (HR: 1.047, p < 0.0001), rural residence area (HR: 3.6, p = 0.025), higher Charlson score (HR: 1.6, p = 0.016), signet-ring cell carcinoma (HR: 2.37, p = 0.009), adjuvant systemic treatment (HR: 1.55, p = 0.015), positive surgical margins (HR: 1.83, p = 0.017), positive lymph nodes number (HR: 1.09, p < 0.0001), and examined lymph nodes number (HR: 0.962, p = 0.001) were independent predictors of OS. CONCLUSIONS Partial colectomy and hemicolectomy had similar OS and clinical outcomes. Older age, rural residence, higher Charlson score, signet-ring pathology, adjuvant systemic treatment, positive surgical margins, positive lymph node number, and examined lymph node number were independent predictors of OS.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Tel Aviv University, Tel Aviv, Israel
| | - Michael R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Emanuela Silva-Alvarenga
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Israel
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
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18
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Solsky I, Patel A, Leonard G, Russell G, Perry K, Votanopoulos KI, Shen P, Levine EA. Distance Traveled and Disparities in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2024; 31:1035-1048. [PMID: 37980711 DOI: 10.1245/s10434-023-14469-1] [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: 04/12/2023] [Accepted: 10/05/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The impact of distance traveled on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) outcomes needs further investigation. METHODS This retrospective study reviewed a prospectively managed single-center CRS/HIPEC 1992-2022 database. Zip codes were used to calculate distance traveled and to obtain data on income and education via census data. Patients were separated into three groups based on distance traveled in miles (local: ≤50 miles, regional: 51-99 miles, distant: ≥100 miles). Descriptive statistics, Kaplan-Meier method, and Cox regression were performed. RESULTS The 1614 patients in the study traveled a median distance of 109.5 miles (interquartile range [IQR], 53.36-202.29 miles), with 23% traveling locally, 23.9% traveling regionally, and 53% traveling distantly. Those traveling distantly or regionally tended to be more white (distant: 87.8%, regional: 87.2%, local: 83.2%), affluent (distant: $61,944, regional: $65,014, local: $54,390), educated (% without high school diploma: distant: 10.6%, regional: 11.5%, local: 13.0%), less often uninsured (distant: 2.3%, regional: 4.6%, local: 5.2%) or with Medicaid (distant: 3.3%, regional: 1.3%, local: 9.7%). They more often had higher Peritoneal Carcinomatosis Index (PCI) scores (distant: 15.4, regional: 15.8, local: 12.7) and R2 resections (distant: 50.3%, regional: 52.2%, local: 40.5%). Median survival did not differ between the groups, and distance traveled was not a predictor of survival. CONCLUSION More than 50% of the patients traveled farther than 100 miles for treatment. Although regionalization of CRS/HIPEC may be appropriate given the lack of survival difference based on distance traveled, those who traveled further had fewer health care disparities but higher PCI scores and more R2 resections, which raises concerns about access to care for the underserved, time to treatment, and surgical quality.
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Affiliation(s)
- Ian Solsky
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Ana Patel
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Grey Leonard
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Gregory Russell
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Kathleen Perry
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | | | - Perry Shen
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Edward A Levine
- Section of Surgical Oncology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
- Division of Surgical Oncology, Department of General Surgery, Medical Center Boulevard, Winston-Salem, NC, USA.
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19
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Okado I, Liu M, Elhajj C, Wilkens L, Holcombe RF. Patient reports of cancer care coordination in rural Hawaii. J Rural Health 2024. [PMID: 38225683 DOI: 10.1111/jrh.12821] [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: 07/11/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Rural residents experience disproportionate burdens of cancer, and poorer cancer health outcomes in rural populations are partly attributed to care delivery challenges. Cancer patients in rural areas often experience unique challenges with care coordination. In this study, we explored patient reports of care coordination among rural Hawaii patients with cancer and compared rural and urban patients' perceptions of cancer care coordination. METHODS 80 patients receiving active treatment for cancer from rural Hawaii participated in a care coordination study in 2020-2021. Participants completed the Care Coordination Instrument, a validated oncology patient questionnaire. FINDINGS Mean age of rural cancer patients was 63.0 (SD = 12.1), and 57.7% were female. The most common cancer types were breast and GI. Overall, rural and urban patients' perceptions of care coordination were comparable (p > 0.05). There were statistically significant differences between rural and urban patients' perceptions in communication and navigation aspects of care coordination (p = 0.02 and 0.04, respectively). Specific differences included a second opinion consultation, clinical trial considerations, and after-hours care. 43% of rural patients reported traveling by air for part or all of their cancer treatment. CONCLUSIONS Findings suggest that while overall perceptions of care coordination were similar between rural and urban patients, differential perceptions of specific care coordination areas between rural and urban patients may reflect limited access to care for rural patients. Improving access to cancer care may be a potential strategy to enhance care coordination for rural patients and ultimately address rural-urban cancer health disparities.
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Affiliation(s)
- Izumi Okado
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Michelle Liu
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Carry Elhajj
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Lynne Wilkens
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Randall F Holcombe
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
- University of Vermont Cancer Center, Department of Medicine, Division of Hematology/Oncology, University of Vermont, Burlington, Vermont, USA
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20
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Sawaf T, Gudipudi R, Ofshteyn A, Sarode AL, Bingmer K, Bliggenstorfer J, Stein SL, Steinhagen E. Disparities in Clinical Trial Enrollment and Reporting in Rectal Cancer: A Systematic Review and Demographic Comparison to the National Cancer Database. Am Surg 2024; 90:130-139. [PMID: 37670471 DOI: 10.1177/00031348231191175] [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: 09/07/2023]
Abstract
BACKGROUND Cancer care guidelines based on clinical trial data in homogenous populations may not be applicable to all rectal cancer patients. The aim of this study was to evaluate whether patients enrolled in rectal cancer clinical trials (CTs) are representative of United States (U.S.) rectal cancer patients. METHODS Prospective rectal cancer CTs from 2010 to 2019 in the United States were systematically reviewed. In trials with multiple arms reporting separate demographic variables, each arm was considered a separate CT group in the analysis. Demographic variables considered in the analysis were age, sex, race/ethnicity, facility location throughout the United States, rural vs urban geography, and facility type. Participant demographics from trial and the National Cancer Database (NCDB) participants were compared using chi-squared goodness of fit and one-sample t-test where applicable. RESULTS Of 50 CT groups identified, 42 (82%) studies reported mean or median age. Trial participants were younger compared to NCDB patients (P < .001 all studies). All but three trials had fewer female patients than NCDB (48.2% female, P < .001). Less than half the CT groups reported on race or ethnicity. Eighteen out of 22 trials (82%) had a smaller percentage of Black patients and 4 out of 8 (50%) trials had fewer Hispanic or Spanish origin patients than the NCDB. No CTs reported comorbidities, socioeconomic factors, or education. CT primary sites were largely at academic centers and in urban areas. CONCLUSION The present study supports the need for improved demographic representation and transparency in rectal cancer clinical trials.
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Affiliation(s)
- Tuleen Sawaf
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rachana Gudipudi
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anuja L Sarode
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Sharon L Stein
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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21
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Ramian H, Sun Z, Yabes J, Jacobs B, Sabik LM. Urban-Rural Differences in Receipt of Cancer Surgery at High-Volume Hospitals and Sensitivity to Hospital Volume Thresholds. JCO Oncol Pract 2024; 20:123-130. [PMID: 37590899 PMCID: PMC10827295 DOI: 10.1200/op.22.00851] [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: 12/22/2022] [Revised: 06/08/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Abstract
Methods for identifying high-volume hospitals affect conclusions about rural cancer care access.
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Affiliation(s)
- Haleh Ramian
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Zhaojun Sun
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Jonathan Yabes
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Bruce Jacobs
- Department of Urology, Division of Health Services Research, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lindsay M. Sabik
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA
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Jiang C, Yabroff KR, Han X. Response to Lin and Lin. J Natl Cancer Inst 2023; 115:1631-1632. [PMID: 37707530 DOI: 10.1093/jnci/djad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Changchuan Jiang
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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23
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Hallgren E, Yeary KHK, DelNero P, Johnson-Wells B, Purvis RS, Moore R, Loveless S, Shealy K, McElfish PA. Barriers, facilitators, and priority needs related to cancer prevention, control, and research in rural, persistent poverty areas. Cancer Causes Control 2023; 34:1145-1155. [PMID: 37526781 PMCID: PMC10547626 DOI: 10.1007/s10552-023-01756-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE The purpose of this study was to identify the barriers, facilitators, and priority needs related to cancer prevention, control, and research in persistent poverty areas. METHODS We conducted three focus groups with 17 providers and staff of primary care clinics serving persistent poverty areas throughout the state of Arkansas. RESULTS We identified multiple barriers, facilitators, and priority needs related to cancer prevention and control at primary care clinics serving persistent poverty areas. Barriers included transportation, medical costs, limited providers and service availability, and patient fear/discomfort with cancer topics. Facilitators identified were cancer navigators and community health events/services, and priority needs included patient education, comprehensive workflows, improved communication, and integration of cancer navigators into healthcare teams. Barriers to cancer-related research were lack of provider/staff time, patient uncertainty/skepticism, patient health literacy, and provider skepticism/concerns regarding patient burden. Research facilitators included better informing providers/staff about research studies and leveraging navigators as a bridge between clinic and patients. CONCLUSION Our results inform opportunities to adapt and implement evidence-based interventions to improve cancer prevention, control, and research in persistent poverty areas. To improve cancer prevention and control, we recommend locally-informed strategies to mitigate patient barriers, improved patient education efforts, standardized patient navigation workflows, improved integration of cancer navigators into care teams, and leveraging community health events. Dedicated staff time for research, coordination of research and clinical activities, and educating providers/staff about research studies could improve cancer-related research activities in persistent poverty areas.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
| | - Karen H K Yeary
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Beverly Johnson-Wells
- UAMS Regional Programs, University of Arkansas for Medical Sciences, West Helena, AR, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Stephanie Loveless
- UAMS Regional Programs, University of Arkansas for Medical Sciences, West Helena, AR, USA
| | - Kristen Shealy
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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Syrnioti G, Eden CM, Johnson JA, Alston C, Syrnioti A, Newman LA. Social Determinants of Cancer Disparities. Ann Surg Oncol 2023; 30:8094-8104. [PMID: 37723358 DOI: 10.1245/s10434-023-14200-0] [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: 07/03/2023] [Accepted: 08/09/2023] [Indexed: 09/20/2023]
Abstract
Cancer is a major public health issue that is associated with significant morbidity and mortality across the globe. At its root, cancer represents a genetic aberration, but socioeconomic, environmental, and geographic factors contribute to different cancer outcomes for selected population subsets. The disparities in the delivery of healthcare affect all aspects of cancer management from early prevention to end-of-life care. In an effort to address the inequality in the delivery of healthcare among socioeconomically disadvantaged populations, the World Health Organization defined social determinants of health (SDOH) as conditions in which people are born, live, work, and age. These factors play a significant role in the disproportionate cancer burden among different population groups. SDOH are associated with disparities in risk factor burden, screening modalities, diagnostic testing, treatment options, and quality of life of patients with cancer. The purpose of this article is to describe a more holistic and integrated approach to patients with cancer and address the disparities that are derived from their socioeconomic background.
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Affiliation(s)
- Georgia Syrnioti
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA.
- Department of Surgery, One Brooklyn Health-Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
| | - Claire M Eden
- Department of Surgery New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Josh A Johnson
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Chase Alston
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Antonia Syrnioti
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Lisa A Newman
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
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25
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Li H, Sahu KK, Kumar SA, Tripathi N, Sayegh N, Nordblad B, Chigarira B, Gupta S, Maughan BL, Agarwal N, Swami U. Access to Care and Healthcare Quality Metrics for Patients with Advanced Genitourinary Cancers in Urban versus Rural Areas. Cancers (Basel) 2023; 15:5171. [PMID: 37958345 PMCID: PMC10647451 DOI: 10.3390/cancers15215171] [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: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Compared to the urban population, patients in rural areas face healthcare disparities and experience inferior healthcare-related outcomes. To compare the healthcare quality metrics and outcomes between patients with advanced genitourinary cancers from rural versus urban areas treated at a tertiary cancer hospital, in this retrospective study, eligible patients with advanced genitourinary cancers were treated at Huntsman Cancer Institute, an NCI-Designated Comprehensive Cancer Center in Utah. Rural-urban commuting area codes were used to classify the patients' residences as being in urban (1-3) or rural (4-10) areas. The straight line distances of the patients' residences from the cancer center were also calculated and included in the analysis. The median household income data were obtained and calculated from "The Michigan Population Studies Center", based on individual zip codes. In this study, 2312 patients were screened, and 1025 eligible patients were included for further analysis (metastatic prostate cancer (n = 679), metastatic bladder cancer (n = 184), and metastatic renal cell carcinoma (n = 162). Most patients (83.9%) came from urban areas, while the remainder were from rural areas. Both groups had comparable demographic profiles and tumor characteristics at baseline. The annual median household income of urban patients was $8604 higher than that of rural patients (p < 0.001). There were fewer urban patients with Medicare (44.9% vs. 50.9%) and more urban patients with private insurance (40.4% vs. 35.1%). There was no difference between the urban and rural patients regarding receiving systemic therapies, enrollment in clinical trials, or tumor genomic profiling. The overall survival rate was not significantly different between the two populations in metastatic prostate, bladder, and kidney cancer, respectively. As available in a tertiary cancer hospital, access to care can mitigate the difference in the quality of healthcare and clinical outcomes in urban versus rural patients.
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Affiliation(s)
- Haoran Li
- Division of Medical Oncology, University of Kansas Cancer Center, Westwood, KS 66205, USA
| | - Kamal Kant Sahu
- Division of Oncology, Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Shruti Adidam Kumar
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, USA
| | - Nishita Tripathi
- Department of Internal Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Nicolas Sayegh
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75235, USA
| | - Blake Nordblad
- Division of Oncology, Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Beverly Chigarira
- Division of Oncology, Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Sumati Gupta
- Division of Oncology, Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Benjamin L. Maughan
- Division of Oncology, Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Neeraj Agarwal
- Division of Oncology, Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Umang Swami
- Division of Oncology, Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
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Reyes Orozco F, Lin M, Tam B, Hur K. Impact of distance to treatment center on tumor stage of nasopharyngeal cancer at presentation. Int Forum Allergy Rhinol 2023; 13:1987-1990. [PMID: 36994941 DOI: 10.1002/alr.23162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Francis Reyes Orozco
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Matthew Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Benjamin Tam
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Kevin Hur
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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27
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Sokale IO, Raza SA, Thrift AP. Disparities in cancer mortality patterns: A comprehensive examination of U.S. rural and urban adults, 1999-2020. Cancer Med 2023; 12:18988-18998. [PMID: 37559501 PMCID: PMC10557857 DOI: 10.1002/cam4.6451] [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: 05/23/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Cancer mortality rates overall in the U.S. have decreased significantly; however, the rate of decline has not been uniform across sociodemographic groups. We aimed to compare trends in cancer mortality rates from 1999 to 2020 between rural and urban individuals and to examine whether any rural-urban differences are uniform across racial and ethnic groups. METHODS We used U.S.-wide data from the National Center for Health Statistics, for all cancer deaths among individuals aged 25 years or older. We estimated average annual percentage change (AAPC) in age-standardized cancer mortality rates in the U.S. by cancer type, rural-urban status, sex, and race and ethnicity. RESULTS There was a larger reduction in cancer mortality rates among individuals from urban (males: AAPC, -1.96%; 95% CI, -2.03, -1.90; females: AAPC, -1.56%; 95% CI, -1.64, -1.48) than rural (males: AAPC, -1.43%; 95% CI, -1.47, -1.39; females: AAPC, -0.93; 95% CI, -1.03, -0.82) areas. AAPCs for cancer types were uniformly higher among urban areas compared with rural areas. Despite overall decreases, deaths rates for liver and pancreas cancers increased, including in the most recent period among males (2012-2020, APC, 1.34; 95% CI, 0.49, 2.20) and females (2013-2020, APC, 1.52; 95% CI, 0.03, 3.02) in rural areas. CONCLUSIONS Cancer death rates decreased in all racial and ethnic populations; however, the rural-urban differences varied by race/ethnicity. The rate of decline in mortality rates were lower in rural areas and death rates for liver and pancreas cancers increased, particularly for individuals living in rural America.
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Affiliation(s)
- Itunu O. Sokale
- Section of Epidemiology and Population Sciences, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Syed Ahsan Raza
- Section of Epidemiology and Population Sciences, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Department of MedicineBaylor College of MedicineHoustonTexasUSA
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTexasUSA
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28
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Vaidya R, Unger JM, Qian L, Minichiello K, Herbst RS, Gandara DR, Neal JW, Leal TA, Patel JD, Dragnev KH, Waqar SN, Edelman MJ, Sigal EV, Adam SJ, Malik S, Blanke CD, LeBlanc ML, Kelly K, Gray JE, Redman MW. Representativeness of Patients Enrolled in the Lung Cancer Master Protocol (Lung-MAP). JCO Precis Oncol 2023; 7:e2300218. [PMID: 37677122 PMCID: PMC10581630 DOI: 10.1200/po.23.00218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/18/2023] [Accepted: 07/20/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE Lung Cancer Master Protocol (Lung-MAP), a public-private partnership, established infrastructure for conducting a biomarker-driven master protocol in molecularly targeted therapies. We compared characteristics of patients enrolled in Lung-MAP with those of patients in advanced non-small-cell lung cancer (NSCLC) trials to examine if master protocols improve trial access. METHODS We examined patients enrolled in Lung-MAP (2014-2020) according to sociodemographic characteristics. Proportions for characteristics were compared with those for a set of advanced NSCLC trials (2001-2020) and the US advanced NSCLC population using SEER registry data (2014-2018). Characteristics of patients enrolled in Lung-MAP treatment substudies were examined in subgroup analysis. Two-sided tests of proportions at an alpha of .01 were used for all comparisons. RESULTS A total of 3,556 patients enrolled in Lung-MAP were compared with 2,215 patients enrolled in other NSCLC studies. Patients enrolled in Lung-MAP were more likely to be 65 years and older (57.2% v 46.3%; P < .0001), from rural areas (17.3% v 14.4%; P = .004), and from socioeconomically deprived neighborhoods (42.2% v 36.7%, P < .0001), but less likely to be female (38.6% v 47.2%; P < .0001), Asian (2.8% v 5.1%; P < .0001), or Hispanic (2.4% v 3.8%; P = .003). Among patients younger than 65 years, Lung-MAP enrolled more patients using Medicaid/no insurance (27.6% v 17.8%; P < .0001). Compared with the US advanced NSCLC population, Lung-MAP under represented patients 65 years and older (57.2% v 69.8%; P < .0001), females (38.6% v 46.0%; P < .0001), and racial or ethnic minorities (14.8% v 21.5%; P < .0001). CONCLUSION Master protocols may improve access to trials using novel therapeutics for older patients and socioeconomically vulnerable patients compared with conventional trials, but specific patient exclusion criteria influenced demographic composition. Further research examining participation barriers for under represented racial or ethnic minorities in precision medicine clinical trials is warranted.
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Affiliation(s)
- Riha Vaidya
- Fred Hutchinson Cancer Center, Seattle, WA
- SWOG Statistics and Data Management Center, Seattle, WA
| | - Joseph M. Unger
- Fred Hutchinson Cancer Center, Seattle, WA
- SWOG Statistics and Data Management Center, Seattle, WA
| | - Lu Qian
- Fred Hutchinson Cancer Center, Seattle, WA
| | - Katherine Minichiello
- Fred Hutchinson Cancer Center, Seattle, WA
- SWOG Statistics and Data Management Center, Seattle, WA
| | | | | | | | | | - Jyoti D. Patel
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Martin J. Edelman
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | | | - Stacey J. Adam
- Foundations for the National Institutes of Health, North Bethesda, MD
| | | | - Charles D. Blanke
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR
| | - Michael L. LeBlanc
- Fred Hutchinson Cancer Center, Seattle, WA
- SWOG Statistics and Data Management Center, Seattle, WA
| | - Karen Kelly
- UC Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Mary W. Redman
- Fred Hutchinson Cancer Center, Seattle, WA
- SWOG Statistics and Data Management Center, Seattle, WA
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Winding S, Shin DGD, Rogers CJ, Ni L, Bay A, Vaughan C, Johnson T, McKay JL, Hackney ME. Referent Values for Commonly Used Clinical Mobility Tests in Black and White Adults Aged 50-95 Years. Arch Phys Med Rehabil 2023; 104:1474-1483. [PMID: 37037292 PMCID: PMC10524633 DOI: 10.1016/j.apmr.2023.03.019] [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: 08/15/2022] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To estimate referent values for performance on clinical mobility tests conducted amongst racially diverse adults aged 50-95 years in the Southeast US. DESIGN This is an observational study of community-dwelling older adults from diverse racial groups who participated in observational and rehabilitative studies conducted from 2011-2019. SETTING Rehabilitation clinics around the greater metropolitan Atlanta, Georgia, region. PARTICIPANTS A total of 314 adults (N=314; 222 women). Individuals were predominantly Black (n=121) or White (n=164), with some participants from other racial groups (n=29). INTERVENTIONS Clinical and demographic data were collected at individual visits for each participant. MAIN OUTCOME MEASURES Four Square Step Test (FSST), timed Up and Go (TUG) test, dual TUG test, 6-minute walk test (6MWT), 30-second chair stand, and gait speed were all used as assessments in each cohort. RESULTS Performance slowly declines with increasing age, with a sharp drop in the ninth decade for preferred forward, backward, and fast gait speed; backward gait cadence; 6MWT, TUG test, dual-task TUG-Cognitive, and the 360° turn test. Declines were also seen in the eighth and ninth decades in the FSST. Among White participants, there were significant overall differences across age groups except in the assessment variable, preferred gait cadence. For Black individuals, there were significant overall differences across age groups for backward gait speed, fast gait speed, TUG-Cognitive, dual task, 6MWT, FSST, and 30-second chair stand. CONCLUSIONS These data enrich current referent values for brief, commonly used clinical tests in a diverse, older Southeast US cohort. These data include representatives of the oldest old cohort. This study will support race- and age-specific fall prevention and mobility-enhancing therapeutic application among older patients in clinical practice.
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Affiliation(s)
- Shamekia Winding
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA
| | - Dong Gun Denny Shin
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA
| | - Casey J Rogers
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Birmingham, AL
| | - Liang Ni
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA
| | - Allison Bay
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA
| | - Camille Vaughan
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA; Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Birmingham, AL; Atlanta VA Center for Visual & Neurocognitive Rehabilitation, Decatur, GA
| | - Theodore Johnson
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Birmingham, AL; Department of Family and Preventative Medicine, Emory University School of Medicine, Atlanta, GA; Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - J Lucas McKay
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA; Department of Neurology, Emory University School of Medicine, Atlanta, GA; Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA
| | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA; Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Birmingham, AL; Atlanta VA Center for Visual & Neurocognitive Rehabilitation, Decatur, GA; Emory School of Nursing, Atlanta, GA; Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA.
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Quinn M, Wright N, Scherdt M, Barton DL, Titler M, Armin JS, Naughton MJ, Wenzel J, Percac-Lima S, Mishra P, Danner SM, Friese CR. A descriptive study of policy and system-level interventions to address cancer survivorship issues across six United States health systems. J Cancer Surviv 2023:10.1007/s11764-023-01440-y. [PMID: 37544977 DOI: 10.1007/s11764-023-01440-y] [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: 04/25/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To describe policy and system-level interventions with potential to improve cancer care at six sites. METHODS In 2016, six institutions received foundation support to develop unique multi-component interventions aimed at improving cancer care for underserved populations. These organizations, located across the United States, participated in a cross-site evaluation to assess the overall initiative impact and to identify potentially promising policy and system-level solutions for dissemination and broader implementation. A health system and policy tracking tool was developed to collect data from each site and included a description of their efforts, strategies employed, and changes achieved (e.g., new policies, clinical protocols). Tracking tool data were analyzed using rapid qualitative analyses and a matrix approach. Semi-structured interviews were conducted with site leaders (N = 65) and were analyzed by thematic analysis. RESULTS Sites reported 20 system and policy efforts, which resulted in improvements to electronic health records and telehealth strategies, changes to hospital/health system policies, and standardized clinical protocols/guidelines, among others. Efforts were aimed at: (1) coordinating care across multiple providers, supported by patient navigators; (2) expanding psychosocial and supportive care; (3) improving patient-provider communication; and (4) addressing barriers to accessing care. Interview analyses provided insights into successful strategies, challenges, and implications of the COVID-19 pandemic on cancer care. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS Despite advances in diagnosis and treatment, cancer care remains inequitable. System-level improvements aimed at eliminating common barriers faced by underserved populations offer opportunities to improve the delivery of equitable, effective, and efficient care.
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Affiliation(s)
- Martha Quinn
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Nathan Wright
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Marylee Scherdt
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Debra L Barton
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Marita Titler
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Julie S Armin
- College of Medicine, The University of Arizona, Tucson, AZ, 85711, USA
| | | | - Jennifer Wenzel
- Schools of Nursing and Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | | | | | - Sankirtana M Danner
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Christopher R Friese
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA
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31
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Collins RA, Chaves N, Lee G, Broekhuis JM, James BC. Urban and Rural Surgical Practice Patterns for Papillary Thyroid Carcinoma. Thyroid 2023; 33:849-857. [PMID: 37014086 PMCID: PMC10398746 DOI: 10.1089/thy.2022.0711] [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] [Indexed: 04/05/2023]
Abstract
Background: The 2015 American Thyroid Association (ATA) guidelines shifted recommendations toward less aggressive management of papillary thyroid cancer (PTC). Subsequently, several studies demonstrated a trend in performing thyroid lobectomy (TL) over total thyroidectomy (TT). However, regional variation has persisted without a clear indication of what factors may be influencing practice variation. We aimed to evaluate the surgical management of PTC in patients in rural and urban settings to assess trends of TL compared with TT following the implementation of the 2015 ATA guidelines. Methods: A retrospective cohort analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2019 of patients with localized PTC <4 cm who underwent TT or TL. Patients were classified as living in urban or rural counties based on the 2013 Rural-Urban Continuum Codes. Procedures performed from 2004 to 2015 were categorized as preguidelines, while those performed from 2016 to 2019 were categorized as postguidelines. Chi-square, Student's t-test, logistic regression, and Cochran-Mantel-Haenszel test were used. Results: A total of 89,294 cases were included in the study. Eighty thousand one hundred and fifty (89.8%) were from urban settings and 9144 (9.2%) were from rural settings. Patients from rural settings were older (52 vs. 50 years, p < 0.001) and had smaller nodules (p < 0.001). On adjusted analysis, patients in rural areas were less likely to undergo TT (adjusted odds ratio 0.81, confidence interval [CI] 0.76-0.87). Before the 2015 guidelines, patients in urban settings had a 24% higher odds of undergoing TT compared with those in rural settings (odds ratio 1.24, CI 1.16-1.32, p < 0.001). There was no difference in the proportions of TT and TL based on setting following guideline implementation (p = 0.185). Conclusions: The 2015 ATA guidelines led to a change in overall practice in surgical management of PTC toward increasing TL. While urban and rural practice variation existed before 2015, both settings had an increase in TL following the guideline change, emphasizing the importance of clinical practice guidelines to ensure best practice in both rural and urban settings.
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Affiliation(s)
- Reagan A. Collins
- Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Natalia Chaves
- Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gillian Lee
- Department of Surgery, Brown University, Providence, Rhode Island, USA
| | - Jordan M. Broekhuis
- Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Benjamin C. James
- Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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32
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Owsley KM, Bradley CJ. Access To Oncology Services In Rural Areas: Influence Of The 340B Drug Pricing Program. Health Aff (Millwood) 2023; 42:785-794. [PMID: 37276477 DOI: 10.1377/hlthaff.2022.01640] [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] [Indexed: 06/07/2023]
Abstract
Rural-urban cancer disparities, including greater mortality rates, are partially attributable to the limited availability of oncology services in rural communities. Without these services, rural residents may experience delays in timely treatment and may be less likely to complete recommended care. The 340B Drug Pricing Program allows eligible not-for-profit and public hospitals to purchase covered outpatient drugs, including high-cost oncology drugs, at discounted prices. Using 2011-20 data, we evaluated the relationship between new enrollment in the 340B program and oncology services initiation in rural general acute care hospitals that lacked oncology services in 2011. Compared with hospitals that remained unenrolled in the 340B program through 2020, hospitals that enrolled during 2012-18 were 8.3 percentage points more likely to have added oncology services as of 2020. The newly participating hospitals that added oncology services were disproportionately located in Medicaid expansion states and in counties with lower uninsurance rates. These findings suggest that the 340B program facilitates expanded access to oncology services in some rural communities, but opportunities remain to address disparities in the most disadvantaged service areas.
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Affiliation(s)
- Kelsey M Owsley
- Kelsey M. Owsley , University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cathy J Bradley
- Cathy J. Bradley, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Rueter J, Anderson EC, Graham LC, Antov A, Helbig P, Gaitor L, Bourne J, Edelman E, Reed EK, Reddi HV, Mockus S, DiPalazzo J, Lu-Emerson C, Inhorn R, Sinclair SJ, Thomas CA, Brooks PL, Rasmussen K, Han P, Liu ET. The Maine Cancer Genomics Initiative: Implementing a Community Cancer Genomics Program Across an Entire Rural State. JCO Precis Oncol 2023; 7:e2200619. [PMID: 37163717 PMCID: PMC10309567 DOI: 10.1200/po.22.00619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 05/12/2023] Open
Abstract
PURPOSE The Maine Cancer Genomics Initiative (MCGI) aimed to overcome patient- and provider-level barriers to using genomic tumor testing (GTT) in rural practices by providing genomic tumor boards (GTBs), clinician education, and access to comprehensive large-panel next-generation sequencing to all patients with cancer in Maine. This paper describes the successful implementation of the initiative and three key services made operative between 2016 and 2020. METHODS A community-inclusive, hub-and-spoke approach was taken to implement the three program components: (1) a centralized GTB program; (2) a modular online education program, designed using an iterative approach with broad clinical stakeholders; and (3) GTT free of charge to clinicians and patients. Implementation timelines, participation metrics, and survey data were used to describe the rollout. RESULTS The MCGI was launched over an 18-month period at all 19 oncology practices in the State. Seventy-nine physicians (66 medical oncologists, 5 gynecologic oncologists, 1 neuro-oncologist, and 7 pediatric oncologists) enrolled on the study, representing 100% of all practicing oncologists in Maine. Between July 2017 and September 2020, 1610 patients were enrolled. A total of 515 cases were discussed by 47 (73%) clinicians in 196 GTBs. Clinicians who participated in the GTBs enrolled significantly more patients on the study, stayed in Maine, and reported less time spent in clinical patient care. CONCLUSION The MCGI was able to engage geographically and culturally disparate cancer care practices in a precision oncology program using a hub-and-spoke model. By facilitating access to GTT, structured education, and GTBs, we narrowed the gap in the implementation of precision oncology in one of the most rural states in the country.
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Affiliation(s)
| | - Eric C. Anderson
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
- Tufts University School of Medicine, Boston, MA
| | | | | | | | | | | | - Emily Edelman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - E. Kate Reed
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Honey V. Reddi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Susan Mockus
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - John DiPalazzo
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
| | | | | | | | | | | | | | - Paul Han
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
| | - Edison T. Liu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
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Bai J, Pugh SL, Eldridge R, Yeager KA, Zhang Q, Lee WR, Shah AB, Dayes IS, D'Souza DP, Michalski JM, Efstathiou JA, Longo JM, Pisansky TM, Maier JM, Faria SL, Desai AB, Seaward SA, Sandler HM, Cooley ME, Bruner DW. Neighborhood Deprivation and Rurality Associated With Patient-Reported Outcomes and Survival in Men With Prostate Cancer in NRG Oncology RTOG 0415. Int J Radiat Oncol Biol Phys 2023; 116:39-49. [PMID: 36736921 PMCID: PMC10106367 DOI: 10.1016/j.ijrobp.2023.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Rurality and neighborhood deprivation can contribute to poor patient-reported outcomes, which have not been systematically evaluated in patients with specific cancers in national trials. Our objective was to examine the effect of rurality and neighborhood socioeconomic and environmental deprivation on patient-reported outcomes and survival in men with prostate cancer in NRG Oncology RTOG 0415. METHODS AND MATERIALS Data from men with prostate cancer in trial NRG Oncology RTOG 0415 were analyzed; 1,092 men were randomized to receive conventional radiation therapy or hypofractionated radiation therapy. Rurality was categorized as urban or rural. Neighborhood deprivation was assessed using the area deprivation index and air pollution indicators (nitrogen dioxide and particulate matter with a diameter less than 2.5 micrometers) via patient ZIP codes. Expanded Prostate Cancer Index Composite measured cancer-specific quality of life. The Hopkins symptom checklist measured anxiety and depression. EuroQoL-5 Dimension assessed general health. RESULTS We analyzed 751 patients in trial NRG Oncology RTOG 0415. At baseline, patients from the most deprived neighborhoods had worse bowel (P = .011), worse sexual (P = .042), and worse hormonal (P = .015) scores; patients from the most deprived areas had worse self-care (P = .04) and more pain (P = .047); and patients from rural areas had worse urinary (P = .03) and sexual (P = .003) scores versus patients from urban areas. Longitudinal analyses showed that the 25% most deprived areas (P = .004) and rural areas (P = .002) were associated with worse EuroQoL-5 Dimension visual analog scale score. Patients from urban areas (hazard ratio, 1.81; P = .033) and the 75% less-deprived neighborhoods (hazard ratio, 0.68; P = .053) showed relative decrease in risk of recurrence or death (disease-free survival). CONCLUSIONS Patients with prostate cancer from the most deprived neighborhoods and rural areas had low quality of life at baseline, poor general health longitudinally, and worse disease-free survival. Interventions should screen populations from deprived neighborhoods and rural areas to improve patient access to supportive care services.
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Affiliation(s)
- Jinbing Bai
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Ronald Eldridge
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Katherine A Yeager
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Qi Zhang
- Department of Geography, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - W Robert Lee
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Amit B Shah
- WellSpan York Cancer Center, York, Pennsylvania
| | - Ian S Dayes
- McMaster University, Juravinski Cancer Center, Hamilton Health Science, Hamilton, Ontario, Canada
| | - David P D'Souza
- School of Medicine & Dentistry, University of Western Ontario Schulich, London, Ontario, Canada
| | | | | | - John M Longo
- Zablocki VAMC and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Jordan M Maier
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Sergio L Faria
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | | | | | | | - Mary E Cooley
- Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Deborah W Bruner
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
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Alsoof D, Kasthuri V, Homer A, Glueck J, McDonald CL, Kuris EO, Daniels AH. County Rurality is Associated with Increased Tumor Size and Decreased Survival in Patients with Ewing Sarcoma. Orthop Rev (Pavia) 2023; 15:74118. [PMID: 37064044 PMCID: PMC10097591 DOI: 10.52965/001c.74118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Background Ewing Sarcoma (ES) is an aggressive tumor affecting adolescents and young adults. Prior studies investigated the association between rurality and outcomes, although there is a paucity of literature focusing on ES. Objective This study aims to determine whether ES patients in rural areas are subject to adverse outcomes. Methods This study utilized the Surveillance, Epidemiology, and End Results (SEER) database. A Poisson regression model was used with controls for race, sex, median county income, and age to determine the association between rurality and tumor size. A multivariate Cox Proportional Hazard Model was utilized, controlling for age, race, gender, income, and tumor size. Results There were 868 patients eligible for analysis, with a mean age of 14.14 years. Of these patients, 97 lived in rural counties (11.18%). Metropolitan areas had a 9.50% smaller tumor size (p<0.0001), compared to non-metropolitan counties. Patients of Black race had a 14.32% larger tumor size (p<0.0001), and male sex was associated with a 15.34% larger tumor size (p<0.0001). The Cox Proportional Hazard model estimated that metropolitan areas had a 36% lower risk of death over time, compared to non-metropolitan areas (HR: 0.64, p ≤ 0.04). Conclusion Patients in metropolitan areas had a smaller tumor size at time of diagnosis and had a more favorable survival rate for cancer-specific mortality compared to patients residing in rural areas. Further work is needed to examine interventions to reduce this discrepancy and investigate the effect of extremely rural and urban settings and why racial disparities occur.
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Ratnapradipa KL, Napit K, Ranta J, Luma LB, Dinkel D, Robinson T, Schabloske L, Watanabe-Galloway S. Qualitative Analysis of Colorectal Cancer Screening in Rural Nebraska. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:652-663. [PMID: 35437633 PMCID: PMC9015281 DOI: 10.1007/s13187-022-02170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 05/20/2023]
Abstract
Compared to urban residents, rural populations are less likely to engage in colorectal cancer (CRC) screening. As part of a statewide cancer needs assessment, we aimed to elicit rural perspectives about CRC screening and resources. We conducted three focus groups with rural Nebraska cancer survivors and caregivers (N = 20) in Spring 2021 using a collective case study design. Participant awareness of and knowledge about CRC screening methods varied across focus groups; overall, 95% of participants had heard of colonoscopy. Participants were less familiar with fecal tests and had confusion about them. Colonoscopy was associated with negative perceptions regarding the time, cost, and discomfort of the preparation and procedure, but some providers did not discuss alternative methods unless the patient resisted colonoscopy. Healthcare providers played a key role educating rural communities about CRC screening recommendations (age, risk) and testing options and being persistent in those recommendations. CRC awareness campaigns should include a variety of communication channels (TV, radio, billboards, health fairs, churches, healthcare settings). Promotion of CRC screening should include education about screening age guidelines, alternative test types, and informed decision-making between provider and patient regarding preferred screening methods based on the pros and cons of each test type. Individuals with a family history of colon issues (Crohn's disease, CRC) are considered high risk and need to be aware that screening should be discussed at earlier ages.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA.
| | - Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA
| | - Jordan Ranta
- Sarpy/Cass Health Department, Papillion, NE, USA
| | - Lady Beverly Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, UNMC, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center (UNMC), NSW, 68198-4395, Omaha, USA
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, UNMC, Omaha, NE, USA
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Zhang AY, Koroukian S, Owusu C, Moore SE, Gairola R. Socioeconomic correlates of health outcomes and mental health disparity in a sample of cancer patients during the COVID-19 pandemic. J Clin Nurs 2023; 32:1173-1185. [PMID: 35233863 PMCID: PMC9115137 DOI: 10.1111/jocn.16266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate socioeconomic, behavioural and healthcare delivery factors that are associated with health outcomes of cancer patients during the COVID-19 pandemic, especially among underserved cancer patients. BACKGROUND Cancer patients are at a higher risk of adverse physical and mental health outcomes during the pandemic than those without cancer. DESIGN Cross-sectional online survey. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines in this study. METHODS The sample comprised 322 individuals diagnosed with incident cancer between January 2019 and January 2020. Demographically, 64% were female, 49% had a college degree, 12% were African American, and 88% were White (77% of the Whites were from metropolitan and 23% from nonmetropolitan areas). Descriptive analysis and multivariable regression analyses of global health status, depression and irritability were performed. RESULTS After adjusting for demographic variables and comorbidity, the feelings of loneliness, crowded living space, lower confidence in taking preventive measures and less satisfaction with telehealth visits were significantly associated with poorer global health, depression and irritability. Daily exercise was associated with better global health, and difficulty in getting medicine was associated with depression and irritability. Moreover, African Americans who felt lonely reported more depression and irritability and those who had less confidence in taking preventive measures reported more irritability than Whites. Respondents having low income and feeling lonely reported more depression than others. CONCLUSIONS In this study, socioeconomic factors (e.g. loneliness or crowded living conditions) were as important to health outcomes during the pandemic as behavioural (e.g. prevention and exercises) and quality-of-care factors (e.g. telehealth, access to medicine). Disparity was more pronounced in the mental health of African Americans and those with low incomes. RELEVANCE TO CLINICAL PRACTICE Healthcare providers should promote social support and physical activity for improving health and reducing mental health disparities among cancer patients.
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Affiliation(s)
- Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Siran Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Cynthia Owusu
- Division of Hematology Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Scott E Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richa Gairola
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Wise Thomas S, Blackwell Young C, Zoellner J, Brock DJP, Isom S, Vitolins M. Feasibility of an Adapted Community-Based Lifestyle Intervention to Prevent Cancer in the Rural South: Healthy Living Partnerships to Prevent Cancer (HELP PC). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:440-447. [PMID: 35076863 PMCID: PMC11279487 DOI: 10.1007/s13187-022-02137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 05/20/2023]
Abstract
Obesity increases risk of cancer onset and promulgates cancer mortality. Healthy Living Partnerships to Prevent Cancer (HELP PC) is an adapted intensive lifestyle intervention that is facilitated by community health workers (CHWs). The primary objective of this one-arm pilot study was to test the feasibility of evaluating HELP PC in a rural community by assessing participant recruitment, retention, and adherence to the intervention. The secondary objectives of this study were to evaluate the feasibility of collecting study measures and analyze intervention effects to inform future studies. Adults of all races and a BMI ≥ 25 kg/m2 who resided in the Dan River Region of Southern Virginia were recruited. Participants received 24 weekly (hour-long) group sessions led by a CHW and two consultations with a registered dietitian (RDN). Seventy-five percent (21/28) of eligible subjects were enrolled (n = 21; mean age = 46 years; 67% African American; 90% female; median BMI = 36.1), and recruitment was completed in 2 weeks. Fifty-two percent (11/21) of participants attended >70% of group sessions (adherence) and 98% of RDN consultations were attended. Eighty-six percent (n=18) of participants completed the 6-month follow-up visit (retention), and showed improvements in moderate physical activity, health literacy, general health, energy, and emotional well-being. Feasibility of HELP PC was established through efficient participant recruitment, modest attendance, high retention, and execution of data collection procedures. Importantly, findings can be applied to advance cancer prevention lifestyle interventions in rural communities.
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Affiliation(s)
- Sherrie Wise Thomas
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, 486 N. Patterson Avenue, Winston-Salem, NC, 27101, USA.
| | - Caroline Blackwell Young
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Donna-Jean P Brock
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Scott Isom
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mara Vitolins
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Peix A, Perez A, Barreda AM. Cancer and Postradiotherapy Cardiotoxicity: How to Face Damage in Women’s Hearts? Eur Cardiol 2023. [DOI: 10.15420/ecr.2022.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Cancer and cardiovascular disease are the two main causes of death worldwide in both men and women. In the past decades, survival rate in cancer patients has substantially improved due to new treatments and developments in radiation therapy (RT). In women, breast cancer (BC) is the leading cause of cancer death and thoracic RT is a main component of the treatment in many cases. Nevertheless, despite new techniques that limit the area receiving RT, cardiac damage is still an important concern in BC patients. In this review, the following aspects will be addressed: pathophysiology of postradiotherapy heart damage in women with BC; mechanisms, diagnosis and prevention/management of heart damage; and future areas of potential research for radiotherapy injury in women.
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Berrian J, Liu Y, Ezenwajiaku N, Moreno‐Aspitia A, Holton SJ, Toriola AT, Colditz GA, Housten AJ, Hall L, Fiala MA, Ademuyiwa FO. Impact of the COVID-19 pandemic on breast, colorectal, lung, and prostate cancer stage at diagnosis according to race. Cancer Med 2023; 12:7381-7388. [PMID: 36404491 PMCID: PMC10067026 DOI: 10.1002/cam4.5439] [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: 09/07/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine if the COVID-19 pandemic has further exacerbated racial disparities in late-stage presentation of breast, colorectal, lung, and prostate cancers. METHODS We conducted a registry-based retrospective study of patients with newly reported diagnoses of breast, colorectal, lung, and prostate cancers between March 2019-June 2019 (pre-COVID-19) and March 2020-June 2020 (early-COVID-19). We compared the volume of new diagnoses and stage at presentation according to race between both periods. RESULTS During the study period, a total of 3528 patients had newly diagnosed cancer; 3304 of which had known disease stages and were included in the formal analyses. 467 (14.1%) were Blacks, and 2743 were (83%) Whites. 1216 (36.8%) had breast, 415 (12.6%) had colorectal, 827 (25%) had lung, and 846 (25.6%) had prostate cancers, respectively. The pre-COVID-19 period included 2120 (64.2%), and the early-COVID-19 period included 1184 (35.8%), representing a proportional 44.2% decline in the volume of new cases of breast, colorectal, lung, and prostate cancers, p < 0.0001. Pre-COVID-19, 16.8% were diagnosed with metastatic disease, versus 20.4% early-COVID-19, representing a proportional increase of 21.4% in the numbers of new cases with metastatic disease, p = 0.01. There was a non-significant proportional decline of 1.9% in Black patients diagnosed with non-metastatic breast, colorectal, lung, and prostate cancers early-COVID-19 (p = 0.71) and a non-significant proportional increase of 7% in Black patients diagnosed with metastatic disease (p = 0.71). Difference-in-difference analyses showed no statistically significant differences in metastatic presentation comparing Black to White patients. CONCLUSION While we identified substantial reductions in the volume of new cancer diagnoses and increases in metastatic presentations due to the COVID-19 pandemic, the impact was similar for White and Black patients.
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Affiliation(s)
| | - Ying Liu
- Washington University School of MedicineSt. LouisMissouriUSA
| | | | | | | | | | | | | | - Lannis Hall
- Washington University School of MedicineSt. LouisMissouriUSA
| | - Mark A. Fiala
- Washington University School of MedicineSt. LouisMissouriUSA
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Cole A, Andrilla CHA, Patterson D, Davidson S, Mendoza J. Measuring the Impact of the COVID-19 Pandemic on Health Behaviors and Health Care Utilization in Rural and Urban Patients with Cancer and Cancer Survivors. CANCER RESEARCH COMMUNICATIONS 2023; 3:215-222. [PMID: 36817949 PMCID: PMC9934461 DOI: 10.1158/2767-9764.crc-22-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/06/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
Healthcare access and health behaviors differ between those living in urban and rural communities and contribute to inequitable cancer health outcomes. The COVID-19 pandemic led to significant disruptions in daily life and healthcare delivery. This cross-sectional survey aimed to measure the impact of the COVID-19 pandemic on the health behaviors of cancer patients and survivors, comparing outcomes for urban and rural respondents. Survey was administered from January 2021-June 2021 to cancer patients or survivors (treated within the last 5 years) at one of six cancer centers in Washington and Idaho. Respondent ZIP code was used to assess rurality using Rural-Urban Commuting Area designation. 515 rural (43.5% of those contacted) and 146 urban (40% of those contacted) cancer patients and survivors participated. Few differences between urban and rural cancer patients and cancer survivors were noted. Rural residents were older (69.2 years vs. 66.9 years). Rural respondents had higher mean alcohol consumption than urban respondents (4.4 drinks per week vs. 2.7 drinks per week). 12.2% of those who reported drinking in the last 30 days also reported increased alcohol consumption since the start of the pandemic, with no difference in reported increased alcohol consumption in rural vs. urban respondents. 38.5% reported decreased physical activity. 20.5% reported cancelling or delaying cancer care due to the COVID-19 pandemic. Delays in cancer healthcare services and worsening health behaviors due to the COVID-19 pandemic may contribute to poorer health outcomes, with few differences between rural and urban cancer patients and cancer survivors.
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Affiliation(s)
- Allison Cole
- Department of Family Medicine, University of Washington, Seattle, Washington
| | | | - Davis Patterson
- Department of Family Medicine, University of Washington, Seattle, Washington
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Salerno EA, Gao R, Fanning J, Gothe NP, Peterson LL, Anbari AB, Kepper MM, Luo J, James AS, McAuley E, Colditz GA. Designing home-based physical activity programs for rural cancer survivors: A survey of technology access and preferences. Front Oncol 2023; 13:1061641. [PMID: 36761969 PMCID: PMC9907024 DOI: 10.3389/fonc.2023.1061641] [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: 10/04/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Background While technology advances have increased the popularity of remote interventions in underserved and rural cancer communities, less is understood about technology access and preferences for home-based physical activity programs in this cancer survivor population. Purpose To determine access, preferences, and needs, for a home-based physical activity program in rural cancer survivors. Methods A Qualtrics Research Panel was recruited to survey adults with cancer across the United States. Participants self-reported demographics, cancer characteristics, technology access and usage, and preferences for a home-based physical activity program. The Godin Leisure Time Exercise Questionnaire (GLTEQ) assessed current levels of physical activity. Descriptive statistics included means and standard deviations for continuous variables, and frequencies for categorical variables. Independent samples t-tests explored differences between rural and non-rural participants. Results Participants (N=298; mean age=55.2 ± 16.5) had a history of cancer (mean age at diagnosis=46.5), with the most commonly reported cancer type being breast (25.5%), followed by prostate (16.1%). 74.2% resided in rural hometowns. 95% of participants reported accessing the internet daily. On a scale of 0-100, computer/laptop (M=63.4) and mobile phone (M=54.6) were the most preferred delivery modes for a home-based physical activity intervention, and most participants preferred balance/flexibility (72.2%) and aerobic (53.9%) exercises. Desired intervention elements included a frequency of 2-3 times a week (53.5%) for at least 20 minutes (75.7%). While there were notable rural disparities present (e.g., older age at diagnosis, lower levels of education; ps<.001), no differences emerged for technology access or environmental barriers (ps>.08). However, bias due to electronic delivery of the survey should not be discounted. Conclusion These findings provide insights into the preferred physical activity intervention (e.g., computer delivery, balance/flexibility exercises) in rural cancer survivors, while highlighting the need for personalization. Future efforts should consider these preferences when designing and delivering home-based interventions in this population.
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Affiliation(s)
- Elizabeth A. Salerno
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Rohana Gao
- Academic Program of Medical Education, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Jason Fanning
- Department of Gerontology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Neha P. Gothe
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Lindsay L. Peterson
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Allison B. Anbari
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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43
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Huh KY, Yu KS, Song I. Analysis of the distribution of trial sites in South Korea using social network analysis. Transl Clin Pharmacol 2023; 31:1-12. [PMID: 37034125 PMCID: PMC10079509 DOI: 10.12793/tcp.2023.31.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/05/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023] Open
Abstract
Location of trial sites can be a potential source of study bias. Considering that clinical trials have been mostly conducted in urban areas, the distribution of trial sites need to be evaluated. We analyzed clinical trial approval data using social network analysis to quantitatively assess the site-by-site connections. The approval list of clinical trials from the Ministry of Food and Drug Safety database between 2014 and 2021 was analyzed. The number of clinical trials per trial site was counted according to the approval year and study phase and evaluated for distribution using empirical cumulative distribution function plots. Trial sites and conducts of a clinical trial were mapped into nodes and edges in the social network analysis, and basic network parameters were obtained. The clinical trials were concentrated at several trial sites. Forty-nine to 60.6% of phase 1 and up to 30% of the other study phases of clinical trials were at the top 5 trial sites. The annual distribution of the number of clinical trials per site was comparable across the study period. Connections among the trial sites in the metropolitan area were prominent. Graph size and density were higher in phase 3 trials than in the other phases. We demonstrated that the conduct of clinical trials was concentrated in the Seoul Metropolitan Area in both number of trials and connections using social network analysis.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - Ildae Song
- Department of Pharmaceutical Science and Technology, Kyungsung University, Busan 48434, Korea
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Katz ML, Stump TE, Monahan PO, Emerson B, Baltic R, Young GS, Madison Hyer J, Paskett ED, Champion VL, Rawl SM. Factors associated with the accurate self-report of cancer screening behaviors among women living in the rural Midwest region of the United States. Prev Med Rep 2022; 30:102063. [PMID: 36531105 PMCID: PMC9747628 DOI: 10.1016/j.pmedr.2022.102063] [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: 06/13/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 11/22/2022] Open
Abstract
This study examines the accuracy of the self-report of up-to-date cancer screening behaviors (Mammography, Papanicolaou (Pap)/Human Papillomavirus (HPV) tests, Fecal Occult Blood Test (FOBT)/Fecal Immunochemical Test (FIT), Colonoscopy) compared to medical record documentation prior to eligibility determination and enrollment in a randomized controlled trial of an intervention to increase cancer screening among women living in rural counties of Indiana and Ohio. Women (n = 1,641) completed surveys and returned a medical record release form from November 2016-June 2019. We compared self-report to medical records for up-to-date cancer screening behaviors to determine the validity of self-report. Logistic regression models identified variables associated with accurate reporting. Women were up-to-date for mammography (75 %), Pap/HPV test (54 %), colonoscopy (53 %), and FOBT/FIT (6 %) by medical record. Although 39.6 % of women reported being up-to-date for all three anatomic sites (breast, cervix, and colon), only 31.8 % were up to date by medical records. Correlates of accurate reporting of up-to-date cancer screening varied by screening test. Approximately-one-third of women in rural counties in the Midwest are up-to-date for all three anatomic sites and correlates of the accurate reporting of screening varied by test. Although most investigators use medical records to verify completion of cancer screening behaviors as the primary outcome of intervention trials, they do not usually use medical records for the routine verification of study eligibility. Study results suggest that future research should use medical record documentation of cancer screening behaviors to determine eligibility for trials evaluating interventions to increase cancer screening.
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Affiliation(s)
- Mira L. Katz
- College of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Timothy E. Stump
- Department of Biostatistics, School of Medicine, Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, United States
| | - Patrick O. Monahan
- Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | - Brent Emerson
- College of Public Health, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Ryan Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Gregory S. Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States
| | - J. Madison Hyer
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Electra D. Paskett
- College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Victoria L. Champion
- School of Nursing, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
| | - Susan M. Rawl
- School of Nursing, Indiana University, Simon Comprehensive Cancer Center, Indianapolis, IN, United States
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45
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Falk D, Tooze JA, Winkfield KM, Bell RA, Morris B, Strom C, Copus E, Shore K, Weaver KE. A comparison of survey incentive methods to recruit rural cancer survivors into cancer care delivery research studies. Cancer Causes Control 2022; 33:1381-1386. [PMID: 35986825 PMCID: PMC10112050 DOI: 10.1007/s10552-022-01621-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
Unconditional (upfront) incentives are proposed to improve acceptance of cancer research among underrepresented, racial/ethnic minority populations, but few studies have tested incentive strategies among rural cancer survivors. Descriptive statistics summarized demographic characteristics of survey respondents, and response rates by arm were compared using Chi-square tests. We compared upfront ($2) and response-based ($10 conditional) incentives in a mailed survey of adult post-treatment rural survivors. Individuals meeting eligibility criteria from the electronic medical record (n = 2,830) were randomized into two incentive arms (n = 1,414 for the upfront arm and n = 1,416 for the contingent arm). Of the total delivered, presumed eligible participants (n = 1,304 upfront arm; n = 1,317 contingent arm), 67.8% were aged 65y+, 49.8% were female, and 95.1% were non-Hispanic white. The response rate for all participants was 18.5%. We received eligible surveys from 281 rural survivors in the first arm (response rate: 21.5%); and 205 surveys in the second arm (response rate: 15.6%). Participants who received the upfront incentive had a higher response rate than those receiving a response-based incentive, X2 (1, 2,621) = 15.53, p < 0.0001. Incentivizing survey completion with an upfront $2 bill encouraged a higher survey response rate; other supplemental strategies are needed to achieve a higher response rate for this population.
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Affiliation(s)
- Derek Falk
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
- Department of Radiation Oncology, Vanderbilt University Medical Center, Preston Research Building, Rm B-1003, 2220 Pierce Ave, Nashville, TN, 37232-5671, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Bonny Morris
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Carla Strom
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Emily Copus
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kelsey Shore
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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46
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Ayuso-Álvarez A, Ortiz C, López-Cuadrado T, Rodríguez-Blázquez C, Fernández-Navarro P, González-Palacios J, Damián J, Galán I. Rural-urban gradients and all-cause, cardiovascular and cancer mortality in Spain using individual data. SSM Popul Health 2022; 19:101232. [PMID: 36188419 PMCID: PMC9516441 DOI: 10.1016/j.ssmph.2022.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
The literature reporting on rural-urban health status disparities remains inconclusive. We analyzed data from a longitudinal population-based study using individual observations. Our results show that the risks of all-cause and cancer mortality are greater in large cities than in other municipalities, with no clear urban-rural gradient. Not differences were found among territories in cardiovascular mortality.
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Affiliation(s)
- Ana Ayuso-Álvarez
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Sociology Department, Faculty of Economic and Business Sciences, Autonomous University of Madrid, Spain
| | - Cristina Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | | | - Pablo Fernández-Navarro
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Bioinformatics and Data Management Group (BIODAMA), National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Javier González-Palacios
- Bioinformatics and Data Management Group (BIODAMA), National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Javier Damián
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
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47
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Ganatra S, Dani SS, Kumar A, Khan SU, Wadhera R, Neilan TG, Thavendiranathan P, Barac A, Hermann J, Leja M, Deswal A, Fradley M, Liu JE, Sadler D, Asnani A, Baldassarre LA, Gupta D, Yang E, Guha A, Brown SA, Stevens J, Hayek SS, Porter C, Kalra A, Baron SJ, Ky B, Virani SS, Kazi D, Nasir K, Nohria A. Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States. JACC CardioOncol 2022; 4:326-337. [PMID: 36213357 PMCID: PMC9537091 DOI: 10.1016/j.jaccao.2022.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.
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Affiliation(s)
- Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Sourbha S. Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Ashish Kumar
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Safi U. Khan
- Department of Cardiovascular Medicine, Houston Methodist, Houston, Texas, USA
| | - Rishi Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tomas G. Neilan
- Cardiovascular Imaging Research Center and Cardio-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Division of Cardiology and Joint Division of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ana Barac
- Cardio-Oncology Program, Department of Cardiology, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, District of Columbia, USA
| | - Joerg Hermann
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Monika Leja
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anita Deswal
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Fradley
- Cardio-Oncology Translational Center of Excellence, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer E. Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Diego Sadler
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | - Aarti Asnani
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Lauren A. Baldassarre
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Yale New Haven Hospital, Yale University, New Haven, Connecticut, USA
| | - Dipti Gupta
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Eric Yang
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Stevens
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Salim S. Hayek
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles Porter
- Cardio-Oncology Program, Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Suzanne J. Baron
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Bonnie Ky
- Cardio-Oncology Translational Center of Excellence, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Salim S. Virani
- Health Policy and Quality Program, Michael E. DeBakey VA Medical Center, Health Services Research and Development Center of Excellence and Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Dhruv Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Khurram Nasir
- Department of Cardiovascular Medicine, Houston Methodist, Houston, Texas, USA
| | - Anju Nohria
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Allen P, Walsh-Bailey C, Hunleth J, Carothers BJ, Brownson RC. Facilitators of Multisector Collaboration for Delivering Cancer Control Interventions in Rural Communities: A Descriptive Qualitative Study. Prev Chronic Dis 2022; 19:E48. [PMID: 35951440 PMCID: PMC9390795 DOI: 10.5888/pcd19.210450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose and Objectives Multisector collaboration is a widely promoted strategy to increase equitable availability, access, and use of healthy foods, safe places for physical activity, social supports, and preventive health care services. Yet fewer studies and resources exist for collaboration among governmental and nongovernmental agencies to address public problems in rural areas, despite an excess burden of risk factors for cancer morbidity and mortality. We aimed to learn about cancer prevention activities and collaboration facilitators among rural informal interagency networks. Evaluation Methods In 2020, researchers conducted semistructured interviews with staff from rural public health and social services agencies, community health centers, and extension offices. Agency staff were from 5 service areas across 27 rural counties in Missouri and Illinois with high poverty rates and excess cancer risks and mortality. We conducted a thematic analysis to code interview transcripts and identify key themes. Results Exchanging information, cohosting annual or one-time events, and promoting other agencies’ services and programs were the most commonly described collaborative activities among the 32 participants interviewed. Participants indicated a desire to improve collaborations by writing more grants together to codevelop ongoing prevention programs and further share resources. Participants expressed needs to increase community outreach, improve referral systems, and expand screenings. We identified 5 facilitator themes: commitment to address community needs, mutual willingness to collaborate, long-standing relationships, smaller community structures, and necessity of leveraging limited resources. Challenges included lack of funding and time, long travel distances, competing priorities, difficulty replacing staff in remote communities, and jurisdictional boundaries. Although the COVID-19 pandemic further limited staff availability for collaboration, participants noted benefits of remote collaborative meetings. Implications for Public Health Rural areas need consistent funding and other resources to support health-improving multisector initiatives. Existing strengths found in the rural underresourced areas can facilitate multisector collaborations for cancer prevention, including long-standing relationships, small community structures, and the need to leverage limited resources.
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Affiliation(s)
- Peg Allen
- Prevention Research Center, Brown School, Washington University in St Louis, MSC 1196-251-46, One Brookings Dr, Washington University in St Louis, St Louis, MO 63130-4838.
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St Louis, St Louis, Missouri
| | - Jean Hunleth
- Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Bobbi J Carothers
- Center for Public Health Systems Science, Brown School, Washington University in St Louis, St Louis, Missouri
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St Louis, St Louis, Missouri.,Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri
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49
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Williams CP, Davidoff A, Halpern MT, Mollica M, Castro K, Allaire B, de Moor JS. Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors. JCO Oncol Pract 2022; 18:e1234-e1246. [PMID: 35947881 PMCID: PMC9377697 DOI: 10.1200/op.21.00875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/13/2022] [Accepted: 06/24/2022] [Indexed: 08/03/2023] Open
Abstract
PURPOSE The relationship between out-of-pocket spending and cost-related medication nonadherence among older rural- and urban-dwelling cancer survivors is not well understood. METHODS This retrospective cohort study used the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource linked data (2007-2015) to investigate the relationship between cancer survivors' cost responsibility in the year before and after report of delaying or not filling a prescription medication because of cost in the past 6 months (cost-related medication nonadherence). Secondary exposures and outcomes included Medicare spending and utilization. Generalized linear models assessed bidirectional relationships between cost-related medication nonadherence, spending, and utilization. Effects of residence were assessed via interaction terms. RESULTS Of 6,591 older cancer survivors, 13% reported cost-related medication nonadherence. Survivors were a median 8 years (interquartile range, 4.5-12.5 years) from their cancer diagnosis, 15% were dually Medicare/Medicaid-eligible, and prostate (40%) and breast (32%) cancer survivors were most prevalent. With every $500 USD increase in patient cost responsibility, risk of cost-related medication nonadherence increased by 3% (risk ratio, 1.03; 95% CI, 1.02 to 1.04). After report of cost-related medication nonadherence, patient cost responsibility was 22% higher (95% CI, 1.11 to 1.32) compared with those not reporting nonadherence, amounting to $523 USD (95% CI, $430 USD to $630 USD). Medicare spending and utilization were also higher before and after report of cost-related nonadherence versus none. For survivors residing in rural (18%) and urban (82%) areas, residence did not modify adherence or cost outcomes. CONCLUSION A bidirectional relationship exists between patient cost responsibility and cost-related medication nonadherence. Interventions reducing urban- and rural-dwelling survivor health care costs and cost-related adherence barriers are needed.
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Affiliation(s)
- Courtney P. Williams
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Amy Davidoff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Michael T. Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Michelle Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Kathleen Castro
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | - Janet S. de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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50
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Darling KW, Kohut M, Leeds S, Anderson EC, Han PK. "Doing Good" in U.S. Cancer Genomics? Valuation practices across the boundaries of research and care in rural community oncology. NEW GENETICS AND SOCIETY 2022; 41:254-283. [PMID: 36589528 PMCID: PMC9799983 DOI: 10.1080/14636778.2022.2091532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/30/2022] [Indexed: 06/17/2023]
Abstract
Genomic Tumour Testing (GTT) is an emerging site of "experimental care" in oncology [Cambrosio, Alberto, Peter Keating, Etienne Vignola-Gagné, Sylvain Besle, and Pascale Bourret. 2018a. "Extending Experimentation: Oncology's Fading Boundary Bbetween Research and Care." New Genetics and Society 37 (3): 207-226. doi: 10.1080/14636778.2018.1487281]. Few efforts to implement GTT have reached community oncology practices or patients living in rural communities within the US. Drawing on interdisciplinary research on a state-wide cancer genomics initiative in the rural US state of Maine, this paper explores the valuation practices within community oncologist and cancer stakeholders accounts of "doing good" within genomic science and care. We contribute to STS literatures on the bio-economy by highlighting the affective dimensions of strategies for managing economic and non-economic values. Clinician and stakeholders negotiated de-economizing and capitalizing modes of doing good as they built local genomic platforms "for Maine." These situated modes of doing good and feeling good via cancer genomics shaped how they navigated the ethical ambiguities of US biomedical markets across the boundaries of research and care.
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Affiliation(s)
| | - Michael Kohut
- Center for Interdisciplinary Public & Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | - Susan Leeds
- Center for Interdisciplinary Public & Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | - Eric C. Anderson
- Center for Interdisciplinary Public & Health Research, MaineHealth Institute for Research, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Paul K.J. Han
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
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