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Renduchintala K, Arevalo M, Fonseca G, Haver MK, Gwede CK, Pabbathi S, Christy SM. Vaccination uptake among post-treatment cancer survivors: A multi-vaccine scoping review. Vaccine 2024; 42:125995. [PMID: 38802291 PMCID: PMC11371527 DOI: 10.1016/j.vaccine.2024.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Our goal was to provide an overview of uptake rates across vaccine types and factors associated with vaccine uptake among cancer survivor populations. METHODS A literature search was conducted using Ovid MEDLINE® ALL (Wolters Kluwer), Embase (Elsevier) and CINAHL Complete (EBSCO) databases and according to PRISMA guidelines. Eligible articles were limited to those examining vaccination uptake among cancer survivors who had completed treatment, reported factors associated with uptake (e.g., barriers and facilitators), and published in English between 2011 and 2021. Two independent reviewers screened citations for inclusion and two performed data abstraction, verified by an arbiter. RESULTS The search returned 4,215 total articles, and 271 duplicates were removed. During abstract/title screening, 212 articles were identified. Following full-text screening, 47 articles/abstracts were found to meet inclusion criteria, 16 articles/abstracts were removed, and 31 studies were included in the review. Among the 31 studies, participant age ranged from 9 years to adults of all ages. Vaccine types included: influenza (n = 18), human papillomavirus (n = 10), pneumococcal (n = 8), hepatitis A/B (n = 1), shingles (n = 1), measles (n = 1), tetanus/diphtheria (n = 1), and haemophilus influenza B (n = 1). Vaccine uptake varied greatly across studies, vaccine types, and participant populations. Factors affecting vaccination uptake included sociodemographic variables and social determinants of health, health beliefs/attitudes/knowledge, provider recommendation, and cancer treatment/clinical variables. CONCLUSIONS Our findings highlight the need for further examining factors associated with vaccine uptake, the need for clinical guidelines that specifically address vaccination among cancer survivors, and potential targets for multi-level interventions to improve vaccination rates among cancer survivor populations.
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Affiliation(s)
- Kavita Renduchintala
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; University of Chicago, 5801 S. Ellis Ave., Chicago, IL 60637, USA.
| | - Mariana Arevalo
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Gabriella Fonseca
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; Edward Via College of Osteopathic Medicine-Carolinas, 350 Howard Street, Spartanburg, SC 29303, USA.
| | | | - Clement K Gwede
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 560 Channelside Dr, Tampa, FL 33602, USA.
| | - Smitha Pabbathi
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 560 Channelside Dr, Tampa, FL 33602, USA
| | - Shannon M Christy
- Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA; University of South Florida, 560 Channelside Dr, Tampa, FL 33602, USA.
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Lara-Morales A, Soto-Ruiz N, Agudelo-Suárez AA, García-Vivar C. Social determinants of health in post-treatment cancer survivors: Scoping review. Eur J Oncol Nurs 2024; 70:102614. [PMID: 38795448 DOI: 10.1016/j.ejon.2024.102614] [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: 11/29/2023] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To identify, analyze and describe the available scientific evidence about the influence of social determinants of health on cancer survivors. METHODS A scoping review was outlined according to the steps described by the Joanna Brigs Institute Reviewer's Manual: selection of studies, data mapping, and results grouping, synthesis and report, was conducted. PubMed, CINAHL, Scopus and LILACS databases were searched from 2011 to 2023. RESULTS Out of a total of 1783 papers initially screened, only 19 studies met the inclusion criteria for the scoping review, focusing on the primary social determinants impacting the health of cancer survivors. These studies were categorized into six main themes: a) employment (challenges in work reintegration and work-place difficulties); b) variations among different ethnic groups; c) disparities based on sex; d) barriers and facilitators in accessing health and social security services; e) the role of support networks and social environments; and f) socioeconomic lever (influence of income and socioeconomic status). CONCLUSIONS Understanding the impact of social determinants on the post-treatment quality of life for cancer survivors is crucial. Comprehensive survivorship care should address not just medical needs but also holistic aspects like social support, education, overall well-being, and improvements in physical and social environments. This multifaceted approach ensures the well-rounded support needed for optimal survivorship outcomes.
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Affiliation(s)
- Alfredo Lara-Morales
- Department of Nursing and Obstetrics, Guanajuato University, C. Pedro Lascurain de Retana, Calzada de Guadalupe, 36700, Guanajuato, Gto, Mexico.
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/n, 31008, Pamplona, Navarra, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | - Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Calle 64 Nº 52-59, 050010, Medellin, Antioquia, Colombia.
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/n, 31008, Pamplona, Navarra, Spain; IdiSNA, Navarra Institute for Health Research, Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
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Lee M, Tsai MH, Tillewein H, Luckey GS. Rural-Urban Disparities in Telemedicine Use Among U.S. Adults with Cancer. Telemed J E Health 2024; 30:1539-1548. [PMID: 38301205 DOI: 10.1089/tmj.2023.0572] [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: 02/03/2024] Open
Abstract
Introduction: The COVID-19 pandemic has resulted in significant changes in health care delivery worldwide, including the widespread adoption of telemedicine. This study examines the prevalence of telemedicine use among cancer survivors in the United States based on rurality and investigates its association with telemedicine use. Methods: The 2021 National Health Interview Survey was used to analyze telemedicine use among cancer survivors during the pandemic. Telemedicine use was the primary outcome, and rurality was the main exposure. Descriptive statistics and multiple logistic regression models were used to examine the association. Results: Out of 27,500 eligible cancer survivors, 51.6% reported using telemedicine in 2021. Telemedicine usage varied across rural areas, with 41.4% of rural cancer survivors using telemedicine compared with 57.5% of cancer survivors in large metropolitan areas (p < 0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared with large metropolitan cancer survivors. Cancer survivors residing in rural areas were 0.56 times less likely (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.41-0.75), and those residing in medium and small metropolitan areas were 0.69 times less likely (OR = 0.69; 95% CI = 0.56-0.86) to report telemedicine use compared with cancer survivors in large metropolitan areas. Conclusions: Substantial disparities in telemedicine use were observed between rural and urban areas among cancer survivors. Rural cancer survivors were less likely to utilize telemedicine during the COVID-19 pandemic. Ensuring equitable access to telemedicine requires continued reimbursement for telemedicine services, along with additional efforts to improve access to and utilization of health care for rural cancer survivors.
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Affiliation(s)
- Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Simmons Cancer Institute at Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Meng-Han Tsai
- Georgia Prevention Institute, Augusta University, Augusta, Georgia, USA
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
| | - Heather Tillewein
- Department of Health and Human Performance, Austin Peay State University, Clarksville, Tennessee, USA
| | - Georgia S Luckey
- Department of Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Birken SA, Peluso AG, Shalowitz DI, Isom S, Wagi CR, Randazzo A, Falk D, Strom C, Bell R, Weaver KE. Primary Care Provider Visits Among Cancer Survivors 5-7 Years Postdiagnosis. JCO Oncol Pract 2024:OP2300699. [PMID: 38776486 DOI: 10.1200/op.23.00699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/11/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Cancer survivors experience better outcomes when primary care providers (PCPs) are engaged in their care. Nearly all survivors have a PCP engaged in their care in the initial 5 years postdiagnosis, but little is known about sustained PCP engagement. We assessed PCP engagement in survivors' care 5-7 years postdiagnosis and characterized survivors most vulnerable to loss to PCP follow-up. METHODS We linked electronic health record ambulatory care and cancer registry data from an National Cancer Institute-Designated Comprehensive Cancer Center to identify eligible survivors (≥18 years; diagnosed with breast, colorectal, or uterine cancer; had an in-network PCP). We used multiple logistic regression to assess associations between survivor demographics, clinical factors, and health care utilization and odds of sustained PCP engagement. RESULTS In 5-7 years postdiagnosis, PCPs were engaged in care for 43% of survivors. Survivors with sustained PCP-engagement were on average 4.6 years older than those without (P < .0001); survivors had 1.36 greater odds of having regular PCP visits for each decade increase in age on cancer diagnosis (P = .0030). Survivors were less likely to be lost to PCP follow-up if diagnosed at an earlier stage with odds at 0.57 and 0.10 for stage I and stage IV, respectively (P = .0005), and had 2.70 greater odds of engagement in care with at least one oncology visit annually 5-7 years postdiagnosis (P < .0001). CONCLUSION Sustained PCP engagement is endorsed as critical by survivors, PCPs, and oncologists. We found most survivors were lost to PCP follow-up 5-7 years postdiagnosis. Our study is among the first to contribute empirical evidence of survivors being lost in transition. Findings from this study demonstrate the need to bridge gaps in long-term care for cancer survivors.
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Affiliation(s)
- Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Alexandra G Peluso
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - David I Shalowitz
- West Michigan Cancer Center, Kalamazoo, MI
- Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Cheyenne R Wagi
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Aliza Randazzo
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Derek Falk
- Department of Population and Quantitative Health Science, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Carla Strom
- Office of Cancer Health Equity, Comprehensive Cancer Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Ronny Bell
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, UNC Chapel Hill, Chapel Hill, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
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McGuire V, Lichtensztajn DY, Tao L, Yang J, Clarke CA, Wu AH, Wilkens L, Glaser SL, Park SL, Cheng I. Variation in patterns of second primary malignancies across U.S. race and ethnicity groups: a Surveillance, Epidemiology, and End Results (SEER) analysis. Cancer Causes Control 2024; 35:799-815. [PMID: 38206498 DOI: 10.1007/s10552-023-01836-2] [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: 05/26/2023] [Accepted: 11/25/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE One in six incident cancers in the U.S. is a second primary cancer (SPC). Although primary cancers vary considerably by race and ethnicity, little is known about the population-based occurrence of SPC across these groups. METHODS Using Surveillance, Epidemiology, and End Results (SEER) 12 data and relative to the general population, we calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for SPC among 2,457,756 Hispanics, non-Hispanic Asian American/Pacific Islanders (NHAAPI), non-Hispanic black (NHB), and non-Hispanic whites (NHW) cancer survivors aged 45 years or older when diagnosed with a first primary cancer (FPC) from 1992 to 2015. RESULTS The risk of second primary bladder cancer after first primary prostate cancer was higher than expected in Hispanic (SIR = 1.18, 95% CI: 1.01-1.38) and NHAAPI (SIR = 1.41, 95% CI: 1.20-1.65) men than NHB and NHW men. Among women with a primary breast cancer, Hispanic, NHAAPI, and NHB women had a nearly 1.5-fold higher risk of a second primary breast cancer, while NHW women had a 6% lower risk. Among men with prostate cancer whose SPC was diagnosed 2 to <12 months, NHB men were at higher risk for colorectal cancer and Hispanic and NHW men for non-Hodgkin's lymphoma. In the same time frame for breast cancer survivors, Hispanic and NHAAPI women were significantly more likely than NHB and NHW women to be diagnosed with a second primary lung cancer. CONCLUSION Future studies of SPC should investigate the role of shared etiologies, stage of diagnosis, treatment, and lifestyle factors after cancer survival across different racial and ethnic populations.
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Affiliation(s)
- Valerie McGuire
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, 94158-2549, USA.
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, 94158-2549, USA
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA, USA
| | - Li Tao
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA, USA
| | - Juan Yang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, 94158-2549, USA
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA, USA
| | - Christina A Clarke
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA, USA
| | - Anna H Wu
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lynne Wilkens
- Epidemiology Program, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Sally L Glaser
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA, USA
| | | | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, 94158-2549, USA
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA, USA
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Arizpe A, Ochoa-Dominguez CY, Navarro S, Kim SE, Queen K, Pickering TA, Farias AJ. Racial/Ethnic Disparities: Discrimination's Impact on Health-Related Quality of Life-An All of Us Cancer Survivors' Cross-sectional Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02006-z. [PMID: 38653897 DOI: 10.1007/s40615-024-02006-z] [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: 01/02/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Discrimination is associated with worse mental and physical health outcomes. However, the associations among cancer survivors are limited. OBJECTIVE We examined whether discrimination is associated with HRQoL and whether adjusting for it reduces racial/ethnic disparities in HRQoL among cancer survivors. METHODS Cross-sectional data from adult cancer survivors who completed surveys on discrimination in the medical settings (DMS), everyday perceived discrimination (PD), and HRQoL in the "All of Us" Program from 2018 to 2022 were assessed. We created a binary indicator for fair-to-poor vs. good-to-excellent physical health and mental health. PD and DMS scores were a continuous measure with higher scores reflecting more discrimination. Multivariable logistic regression models tested whether DMS and PD are associated with HRQoL and whether they differently affect the association between race/ethnicity and HRQoL. RESULTS The sample (N = 16,664) of cancer survivors was predominantly White (86%) and female (59%), with a median age of 69. Every 5-unit increase in DMS and PD scores was associated with greater odds of fair-to-poor physical health (DMS: OR [95%CI] = 1.66 [1.55, 1.77], PD: 1.33 [1.27, 1.40]) and mental health (DMS: 1.57 [1.47, 1.69], PD: 1.33 [1.27, 1.39]). After adjusting for DMS or PD, Black and Hispanic survivors had a decreased likelihood of fair-to-poor physical health and mental health (decrease estimate range: - 6 to - 30%) compared to White survivors. This effect was greater for Black survivors when adjusting for PD, as the odds of fair-to-poor mental health compared to White survivors were no longer statistically significant (1.78 [1.32, 2.34] vs 1.22 [0.90, 1.64]). CONCLUSION Experiences of discrimination are associated with lower HRQoL and reducing it may mitigate racial/ethnic disparities in HRQoL.
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Affiliation(s)
- Angel Arizpe
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | | | - Stephanie Navarro
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Sue E Kim
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Katelyn Queen
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Trevor A Pickering
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Albert J Farias
- Keck School of Medicine of the University of Southern California, 1845 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
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Arizpe A, Navarro S, Ochoa-Dominguez CY, Rodriguez C, Kim SE, Farias AJ. Nativity differences in socioeconomic barriers and healthcare delays among cancer survivors in the All of Us cohort. Cancer Causes Control 2024; 35:203-214. [PMID: 37679534 PMCID: PMC10787892 DOI: 10.1007/s10552-023-01782-z] [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: 04/22/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE We aimed to assess whether nativity differences in socioeconomic (SES) barriers and health literacy were associated with healthcare delays among US cancer survivors. METHODS "All of Us" survey data were analyzed among adult participants ever diagnosed with cancer. A binary measure of healthcare delay (1+ delays versus no delays) was created. Health literacy was assessed using the Brief Health Literacy Screen. A composite measure of SES barriers (education, employment, housing, income, and insurance statuses) was created as 0, 1, 2, or 3+. Multivariable logistic regression model tested the associations of (1) SES barriers and health literacy with healthcare delays, and (2) whether nativity modified this relationship. RESULTS Median participant age was 64 years (n = 10,020), with 8% foreign-born and 18% ethnic minorities. Compared to survivors with no SES barriers, those with 3+ had higher likelihood of experiencing healthcare delays (OR 2.18, 95% CI 1.84, 2.58). For every additional barrier, the odds of healthcare delays were greater among foreign-born (1.72, 1.43, 2.08) than US-born (1.27, 1.21, 1.34). For every 1-unit increase in health literacy among US-born, the odds of healthcare delay decreased by 9% (0.91, 0.89, 0.94). CONCLUSION We found that SES barriers to healthcare delays have a greater impact among foreign-born than US-born cancer survivors. Higher health literacy may mitigate healthcare delays among US cancer survivors. Healthcare providers, systems and policymakers should assess and address social determinants of health and promote health literacy as a way to minimize healthcare delays among both foreign- and US-born cancer survivors.
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Affiliation(s)
- Angel Arizpe
- Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Stephanie Navarro
- Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | | | | | - Sue E Kim
- Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Albert J Farias
- Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
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8
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Meernik C, Dorfman CS, Zullig LL, Lazard AJ, Fish L, Farnan L, Nichols HB, Oeffinger KC, Akinyemiju T. Health Care Access Barriers and Self-Reported Health Among Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2024; 13:112-122. [PMID: 37307018 DOI: 10.1089/jayao.2023.0024] [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: 06/13/2023] Open
Abstract
Purpose: Adolescents and young adult (AYA) cancer survivors (15-39 years at diagnosis) are at risk for treatment-related late effects but face barriers in accessing survivorship care. We examined the prevalence of five health care access (HCA) barriers: affordability, accessibility, availability, accommodation, and acceptability. Methods: We identified AYA survivors from the University of North Carolina (UNC) Cancer Survivorship Cohort who completed a baseline questionnaire in 2010-2016. Participants had a history of cancer, were ≥18 years of age, and receiving care at a UNC oncology clinic. The sample was restricted to AYA survivors who were interviewed ≥1 year postdiagnosis. We used modified Poisson regression to estimate prevalence ratios (PRs) for the association between HCA barriers and self-reported fair or poor health, adjusted for sociodemographic and cancer characteristics. Results: The sample included 146 AYA survivors who were a median age of 39 at the time of the survey. The majority (71%)-and 92% of non-Hispanic Black survivors-reported at least one HCA barrier, including acceptability (40%), accommodation (38%), or affordability (31%). More than one-quarter of survivors (28%) reported fair or poor health. Affordability barriers (PR: 1.89, 95% confidence interval [CI]: 1.13-3.18) and acceptability barriers (PR: 1.60, 95% CI: 0.96-2.66) were associated with a higher prevalence of fair/poor health, as were the cumulative effects of multiple HCA dimensions reported as barriers. Conclusions: Barriers across multiple HCA dimensions were prevalent and associated with worse health in AYA survivors. Findings highlight the need to better understand and target specific barriers to care for diverse AYA survivors to improve their long-term health.
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Affiliation(s)
- Clare Meernik
- Department of Population Health Sciences and Duke University School of Medicine, Durham, North Carolina, USA
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Leah L Zullig
- Department of Population Health Sciences and Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hazel B Nichols
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences and Duke University School of Medicine, Durham, North Carolina, USA
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9
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Rosenthal A, Duvall A, Kahn J, Khan N. Disparities in care and outcomes for adolescent and young adult lymphoma patients. EJHAEM 2023; 4:934-939. [PMID: 38024615 PMCID: PMC10660400 DOI: 10.1002/jha2.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023]
Abstract
Though survival outcomes among adolescents and young adults (AYAs) with lymphoma have improved over the last three decades, socially vulnerable populations including non-White, low-income, and publicly insured groups continue to trail behind on survival curves. These disparities, while likely the result of both biological and non-biological factors, can be largely attributed to inequities in care over the full cancer continuum. Nationally representative studies have demonstrated that from diagnosis through therapy and into long-term survivorship, socially vulnerable AYAs with lymphoma face barriers to care that impact their short and long-term survival. Thus, improving outcomes for all AYAs with lymphoma requires dedicated study to understand, and then address the unique challenges faced by non-White and low-income lymphoma populations within this age group.
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Affiliation(s)
- Allison Rosenthal
- Mayo Clinic Arizona Division of Hematology Medical OncologyPhoenixArizonaUSA
| | - Adam Duvall
- Department of MedicineSection of Hematology/OncologyUniversity of ChicagoChicagoIllinoisUSA
| | - Justine Kahn
- Department of PediatricsDivision of Pediatric Hematology/Oncology/Stem Cell TransplantationColumbia University Medical CenterNew YorkNew YorkUSA
| | - Niloufer Khan
- Department of Hematology and Hematopoietic Cell Transplantation DuarteCity of HopeDuarteCanada
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10
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Berkman AM, Andersen CR, Roth ME, Gilchrist SC. Cardiovascular disease in adolescent and young adult cancer survivors: Impact of sociodemographic and modifiable risk factors. Cancer 2023; 129:450-460. [PMID: 36464957 DOI: 10.1002/cncr.34505] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/10/2022] [Accepted: 09/19/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a growing population of adolescent and young adult (AYA) cancer survivors (ages 15-39 years), and they have an elevated risk of developing cardiovascular disease (CVD). Little is known about the contribution of sociodemographic and modifiable factors to the risk of CVD in AYA survivors and whether these factors differentially modulate their risk compared with that in the general population. The current study sought to fill these gaps. METHODS Self-reported data from the US National Health Interview Survey (2009-2018) were used to identify AYA cancer survivors (≥2 years postdiagnosis) and age-matched and sex-matched controls. The risk of CVD based on sociodemographic factors (sex, race/ethnicity, income, education) and modifiable risk factors (diabetes, body mass index, smoking, physical activity) was determined within and between survivors and controls using logistic regression models. RESULTS In total, 4766 AYA cancer survivors and 47,660 controls were included. The odds of CVD were significantly higher in survivors than in controls by sex, race/ethnicity, income, education, smoking status, and physical activity. An annual household income <$50,000 disproportionately increased the odds of CVD in survivors. One third of survivors reported no moderate-to-vigorous-intensity physical activity (MVPA). Performing any MVPA lowered the odds of CVD in survivors (odds ratio, 0.61; 95% CI, 0.450.81) and controls (odds ratio, 0.68; 95% CI, 0.61-0.77). CONCLUSIONS Sociodemographic and modifiable risk factors increased the odds of CVD in AYA survivors, in some cases disproportionately, compared with controls. Understanding health behavior trajectories among different sociodemographic populations is needed to identify opportunities to lower the risk of CVD. Performing any MVPA is particularly important for AYA survivors.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan C Gilchrist
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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Dibble KE, Kaur M, Connor AE. Disparities in healthcare utilization and access by length of cancer survivorship among population-based female cancer survivors. J Cancer Surviv 2022; 16:1220-1235. [PMID: 34661881 PMCID: PMC9013726 DOI: 10.1007/s11764-021-01110-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/07/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The current study examined disparities in the associations between medically vulnerable populations and healthcare-related outcomes among population-based female cancer survivors and determined if these associations differed by length of cancer survivorship. METHODS One thousand eight hundred ninety-seven women with a cancer history from the National Health and Nutrition Examination Survey from 1999 to 2016 contributed data. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated with multivariable logistic regression models to measure the associations between the predictors (race/ethnicity, poverty status, education, comorbidity status, US nativity) and outcomes (perceived health, healthcare utilization and access outcomes), overall and by length of survivorship. RESULTS There was an average of 14.3 years (SD = 11.7; range = 2-84) since initial cancer diagnosis, with 25.1% being short-term and 74.9% being long-term survivors. Overall, racial/ethnic minority women were more likely to report poor/fair health status (OR, 2.68; 95% CI 1.73-4.15) and utilizing routine care other than a doctor's office/HMO (OR, 1.61; 95% CI 1.12-2.29) in comparison with NHW survivors. Length of survivorship significantly modified the association between race/ethnicity and odds of seeing a mental health provider in the last year (p-interaction = 0.003), with short-term minority survivors being significantly more likely (OR, 2.63; 95% CI 1.29-5.35) and long-term minority survivors being less likely (OR, 0.68; 95% CI 0.37-1.23). CONCLUSIONS Racial/ethnic disparities exist among female cancer survivors for perceived health status and certain healthcare utilization outcomes, with some differences observed by length of cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS This study can begin to inform cancer survivorship care for medically vulnerable women along the cancer continuum.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Maneet Kaur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, 21205, USA
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12
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Ojinnaka CO, Bruening M. Black-White racial disparities in health care utilization and self-reported health among cancer survivors: The role of food insecurity. Cancer 2021; 127:4620-4627. [PMID: 34415573 DOI: 10.1002/cncr.33871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Non-Hispanic Blacks continue to have worse cancer outcomes than non-Hispanic Whites. Suboptimal health care utilization and poor self-reported health among non-Hispanic Blacks contribute to these disparities. The relationship between race, food security status (FSS), and health care utilization or self-reported health among cancer survivors is not clear. This study aims to fill this gap in the science. METHODS The 2011-2018 National Health Interview Survey data were used. Bivariate and multivariable logistic regression analyses were used to examine the relationship between race (non-Hispanic Whites or non-Hispanic Blacks), FSS (high, marginal, low, or very low), health care utilization, and self-reported health among cancer survivors. Analyzed health care utilization measures included cost-related medication underuse (CRMU), cost-related delayed care, cost-related forgone care, seeing/talking to a medical specialist, seeing/talking to a general doctor, and overnight hospital stay. RESULTS A higher proportion of Blacks reported very low food security in comparison with Whites (10.58% vs 4.24%; P ≤ .0001). Blacks were significantly less likely to report a medical specialist visit and more likely to report fair/poor health in the past 12 months even after adjustments for FSS. There was a dose-response relationship between FSS and CRMU, cost-related delayed care, cost-related forgone care, overnight hospital stay, and self-reported health status for both Whites and Blacks. CONCLUSIONS Significant disparities in health care utilization and self-reported health across race and FSS persist among cancer survivors. Interventions that target food insecurity have the potential to reduce suboptimal health care utilization and self-reported health among cancer survivors.
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Affiliation(s)
| | - Meg Bruening
- College of Health Solutions, Arizona State University, Phoenix, Arizona
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13
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Berkman AM, Andersen CR, Puthenpura V, Livingston JA, Ahmed S, Cuglievan B, Hildebrandt MAT, Roth ME. Disparities in the long-term survival of adolescent and young adult diffuse large B cell lymphoma survivors. Cancer Epidemiol 2021; 75:102044. [PMID: 34597882 DOI: 10.1016/j.canep.2021.102044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE The population of adolescent and young adult (AYA, ages 15-39 years) diffuse large B-cell lymphoma (DLBCL) survivors is growing, however long-term overall survival patterns and disparities are largely unknown. METHODS The current study utilized the Surveillance, Epidemiology, and End Results (SEER) registry to assess the impact of race/ethnicity, sex, socioeconomic status, and rurality on long-term survival in 5-year DLBCL survivors using an accelerated failure time model. RESULTS Included were 4767 5-year survivors of AYA DLBCL diagnosed between the years 1980 and 2009 with a median follow-up time of 13.4 years. Non-Hispanic Black survivors had significantly worse long-term survival than non-Hispanic White survivors (Survival Time Ratio (STR): 0.53, p < 0.0001). Male sex (STR: 0.57, p < 0.0001) and older age at diagnosis were also associated with reduced long-term survival. There was no evidence that survival disparities improved over time. CONCLUSIONS Racial disparities persist well into survivorship among AYA DLBCL survivors. Studies investigating specific factors associated with survival disparities are urgently needed to better address these disparities.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Clark R Andersen
- Division of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vidya Puthenpura
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - J A Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Branko Cuglievan
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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14
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Berkman AM, Andersen CR, Puthenpura V, Livingston JA, Ahmed S, Cuglievan B, Hildebrandt MAT, Roth ME. Impact of Race, Ethnicity, and Socioeconomic Status over Time on the Long-term Survival of Adolescent and Young Adult Hodgkin Lymphoma Survivors. Cancer Epidemiol Biomarkers Prev 2021; 30:1717-1725. [PMID: 34244160 DOI: 10.1158/1055-9965.epi-21-0103] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 06/23/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although there are growing numbers of adolescent and young adult (AYA) Hodgkin lymphoma (HL) survivors, long-term overall survival (OS) patterns and disparities in this population are underreported. The aim of the current study was to assess the impact of race/ethnicity, socioeconomic status (SES), rurality, diagnosis age, sex, and HL stage over time on long-term survival in AYA HL survivors. METHODS The authors used the Surveillance, Epidemiology, and End Results (SEER) registry to identify survivors of HL diagnosed as AYAs (ages 15-39 years) between the years 1980 and 2009 and who were alive 5 years after diagnosis. An accelerated failure time model was used to estimate survival over time and compare survival between groups. RESULTS There were 15,899 5-year survivors of AYA HL identified, with a median follow-up of 14.4 years and range up to 33.9 years from diagnosis. Non-Hispanic black survivors had inferior survival compared with non-Hispanic white survivors [survival time ratio (STR): 0.71, P = 0.002]. Male survivors, older age at diagnosis, those diagnosed at higher stages, and those living in areas of higher SES deprivation had unfavorable long-term survival. There was no evidence of racial or sex-based survival disparities changing over time. CONCLUSIONS Racial, SES, and sex-based disparities persist well into survivorship among AYA HL survivors. IMPACT Disparities in long-term survival among AYA HL survivors show no evidence of improving over time. Studies investigating specific factors associated with survival disparities are needed to identify opportunities for intervention.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Clark R Andersen
- Division of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vidya Puthenpura
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - J Andrew Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Branko Cuglievan
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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15
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Somayaji D, Melendez M, Kwon M, Lathan C. Access to Cancer Care Resources in a Federally Qualified Health Center: a Mixed Methods Study to Increase the Understanding of Met and Unmet Needs of Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:591-602. [PMID: 31828550 DOI: 10.1007/s13187-019-01669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Assessing the met and unmet needs of cancer survivors is critical in optimizing access to cancer services especially in underserved populations. The purpose of this study is to expand our understanding of the priority needs for cancer survivorship within racial/ethnic and underserved populations that speak either English or Spanish and seek health care in a federally qualified health center (FQHC). A convergent mixed methods design integrating survey and focus group data was utilized for this study. A total of 17 participants were enrolled in the study. The meta-inferences were drawn by looking across the top ten matched survey and focus group met and unmet needs including psychological, informational, and health system as well as patient care and support. The preferred languages of participants were Spanish 53% (n = 9) and English 47% (n = 8), and the survival breakdown was 65% (n = 11) within 0-5 years with 17.5% (n = 3), 6-10 years and 17.5% (n = 3), and 17.5% (n = 3) > 11 years. The most frequently met needs included health care providers and hospital staff being attentive to their physical and emotional needs and feeling they were treated with respect. Unmet needs were often related to physical and daily living needs such as pain, fatigue, sadness, depression, and not being able to work. Providing a needs-based approach of cancer health services in a FQHC or similar community-based health center is critical to meet the needs of cancer survivors to improve health outcomes and quality of life.
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Affiliation(s)
- Darryl Somayaji
- School of Nursing, University at Buffalo, 3435 Main St, Wende Hall 201C, Buffalo, NY, 14214, USA.
| | | | - Misol Kwon
- School of Nursing, University at Buffalo, 3435 Main St, Wende Hall 201C, Buffalo, NY, 14214, USA
| | - Christopher Lathan
- Dana Farber/Harvard Cancer Center Medicine Department, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA
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16
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Coughlin SS, Chen J, Cortes JE. Health care access and utilization among adult cancer survivors: Results from the National Institutes of Health "All of Us" Research Program. Cancer Med 2021; 10:3646-3654. [PMID: 33942535 PMCID: PMC8178490 DOI: 10.1002/cam4.3924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/06/2023] Open
Abstract
Background Many cancer survivors face financial difficulties that prevent them from receiving appropriate health care. Racial/ethnic disparities in receipt of health care have been reported among cancer survivors, but recent data for important racial/ethnic subgroups of the US population are lacking. Methods To learn more about barriers to healthcare access faced by cancer survivors, we analyzed data from the NIH “All of Us” Research Program. Data were analyzed about demographic factors and other personal characteristics, personal medical history of cancer, healthcare utilization, and access to care. Results As of November 2020, a total of 5426 participants had a history of cancer (excluding skin cancer). About 88.2% were non‐Hispanic White; 3.9% were Black, African American, or African; 1.3% were Asian; 4.1% were Hispanic, Latino, or Spanish; and 1.2% reported more than one race. Just over one‐half had an annual income of $75,000 or greater. The majority of the participants (71.7%) were college graduates or had an advanced degree. About 47.0%% had private health insurance, 41.0% had Medicare, 6.0% had Medicaid, and the remainder had military, Veterans Affairs, other insurance, or no health insurance. Frequently cited reasons for delayed care in the past 12 months were “had to pay out of pocket for some or all of the procedures,” “deductible was too high/or could not afford the deductible,” “couldn't afford the copay,” “couldn't get time off work,” and “were nervous about seeing a health care provider.” Discussion A minority of cancer survivors who participated in the NIH “All of Us” Program had difficulty paying for health care in the past 12 months. Of particular concern are minorities such as African American and Hispanic cancer survivors along with those who are low income. Many cancer survivors face financial problems that prevent them from receiving timely and recommended health care. A minority of cancer survivors who participated in the NIH “All of Us” Research Program had difficulty paying for health care in the past 12 months. Of particular concern are minorities such as African American and Hispanic cancer survivors along with those who are low income.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Jie Chen
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta University, Augusta, GA, USA
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17
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Kern LM, Rajan M, Colantonio LD, Reshetnyak E, Ringel JB, Muntner PM, Casalino LP, Pinheiro LC, Safford MM. Differences in ambulatory care fragmentation by race. BMC Health Serv Res 2021; 21:154. [PMID: 33596897 PMCID: PMC7890852 DOI: 10.1186/s12913-021-06133-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with more subsequent healthcare utilization (such as more tests, procedures, emergency department visits, and hospitalizations) than less fragmented ambulatory care. It is not known if race and socioeconomic status are associated with fragmented ambulatory care. METHODS We conducted a longitudinal analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, using the REGARDS baseline visit plus the first year of follow-up. We included participants ≥65 years old, who had linked fee-for-service Medicare claims, and ≥ 4 ambulatory visits in the first year of follow-up. We used Tobit regression to determine the associations between race, annual household income, and educational attainment at baseline and fragmentation score in the subsequent year (as measured with the reversed Bice-Boxerman Index). Covariates included other demographic characteristics, medical conditions, medication use, health behaviors, and psychosocial variables. Additional analyses categorized visits by the type of provider (primary care vs. specialist). RESULTS The study participants (N = 6799) had an average age of 73.0 years, 53% were female, and 30% were black. Nearly half had low annual household income (<$35,000) and 41% had a high school education or less. Overall, participants had a median of 10 ambulatory visits to 4 providers in the 12 months following their baseline study visit. Participants in the highest quintile of fragmentation scores had a median of 11 visits to 7 providers. Black race was associated with an absolute adjusted 3% lower fragmentation score compared to white race (95% confidence interval (2% lower to 4% lower; p < 0.001). This difference was explained by blacks seeing fewer specialists than whites. Income and education were not independent predictors of fragmentation scores. CONCLUSIONS Among Medicare beneficiaries, blacks had less fragmented ambulatory care than whites, due to lower utilization of specialty care. Future research is needed to determine the effect of fragmented care on health outcomes for blacks and whites.
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Affiliation(s)
- Lisa M Kern
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA.
| | - Mangala Rajan
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | | | - Evgeniya Reshetnyak
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Joanna Bryan Ringel
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Paul M Muntner
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lawrence P Casalino
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Laura C Pinheiro
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
| | - Monika M Safford
- Weill Cornell Medicine, 420 East 70th Street, Box 331, New York, NY, 10021, USA
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18
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Lin AW, Baik SH, Aaby D, Tello L, Linville T, Alshurafa N, Spring B. eHealth Practices in Cancer Survivors With BMI in Overweight or Obese Categories: Latent Class Analysis Study. JMIR Cancer 2020; 6:e24137. [PMID: 33156810 PMCID: PMC7746487 DOI: 10.2196/24137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background eHealth technologies have been found to facilitate health-promoting practices among cancer survivors with BMI in overweight or obese categories; however, little is known about their engagement with eHealth to promote weight management and facilitate patient-clinician communication. Objective The objective of this study was to determine whether eHealth use was associated with sociodemographic characteristics, as well as medical history and experiences (ie, patient-related factors) among cancer survivors with BMI in overweight or obese categories. Methods Data were analyzed from a nationally representative cross-sectional survey (National Cancer Institute’s Health Information National Trends Survey). Latent class analysis was used to derive distinct classes among cancer survivors based on sociodemographic characteristics, medical attributes, and medical experiences. Logistic regression was used to examine whether class membership was associated with different eHealth practices. Results Three distinct classes of cancer survivors with BMI in overweight or obese categories emerged: younger with no comorbidities, younger with comorbidities, and older with comorbidities. Compared to the other classes, the younger with comorbidities class had the highest probability of identifying as female (73%) and Hispanic (46%) and feeling that clinicians did not address their concerns (75%). The older with comorbidities class was 6.5 times more likely than the younger with comorbidities class to share eHealth data with a clinician (odds ratio [OR] 6.53, 95% CI 1.08-39.43). In contrast, the younger with no comorbidities class had a higher likelihood of using a computer to look for health information (OR 1.93, 95% CI 1.10-3.38), using an electronic device to track progress toward a health-related goal (OR 2.02, 95% CI 1.08-3.79), and using the internet to watch health-related YouTube videos (OR 2.70, 95% CI 1.52-4.81) than the older with comorbidities class. Conclusions Class membership was associated with different patterns of eHealth engagement, indicating the importance of tailored digital strategies for delivering effective care. Future eHealth weight loss interventions should investigate strategies to engage younger cancer survivors with comorbidities and address racial and ethnic disparities in eHealth use.
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Affiliation(s)
- Annie Wen Lin
- Department of Nutrition, Benedictine University, Lisle, IL, United States.,Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Sharon H Baik
- Department of Supportive Care Medicine, City of Hope Medical Cancer Center, Duarte, CA, United States.,Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - David Aaby
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Leslie Tello
- Department of Nutrition, Benedictine University, Lisle, IL, United States
| | - Twila Linville
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Nabil Alshurafa
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
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19
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Mitchell JA, Perry R. Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study. PLoS One 2020; 15:e0238356. [PMID: 32991624 PMCID: PMC7523955 DOI: 10.1371/journal.pone.0238356] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 08/14/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample. METHODS We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health. RESULTS Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency. IMPLICATIONS Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.
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Affiliation(s)
- Jamie A Mitchell
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Ramona Perry
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
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20
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Lee M, Jenkins WD, Adjei Boakye E. Cancer screening utilization by residence and sexual orientation. Cancer Causes Control 2020; 31:951-964. [PMID: 32833199 DOI: 10.1007/s10552-020-01339-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation. METHODS Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors. RESULTS Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24-0.73 and aOR = 0.79; 95% = 0.72-0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80-0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41-0.94) than heterosexuals, and there were no differences for breast screening. CONCLUSION We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.
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Affiliation(s)
- Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA. .,Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.,Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA
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21
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Song YM, Shin J, Ko H, Yoo JE, Cho IY, Shin DW, Cho B, Lee JE, Hwang J, Lee J. Factors associated with pneumococcal vaccination uptake by cancer survivors. J Cancer Surviv 2020; 15:234-243. [PMID: 32779103 DOI: 10.1007/s11764-020-00927-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to evaluate factors associated with pneumococcal vaccination uptake (PVU) of cancer survivors. METHODS A total of 2032 Korean adult cancer survivors diagnosed between June of 1975 and February of 2018 have participated. Information on PVU status and selected variables were collected through self-administered questionnaires and medical record review. Factors associated PVU were investigated using multiple logistic regression analysis. RESULTS PVU rate markedly differed by age strata and cancer sites: 73.9% for elderly (≥ 65 years) survivors and 34.6% for younger (< 65 years) survivors and 73.4% for lung cancer survivors and 42.1% for non-lung cancer survivors. Regular physical exercise was associated with higher PVU in both age groups: Odds ratio (OR) and 95% confidence interval (CI) were 1.52 (1.20, 1.94) for younger and 1.78 (1.09, 2.90) for elderly survivors. Complementary medication use was positively associated with PVU with borderline significance in both age groups. However, the association of PVU with other factors differed between the two age groups. In younger survivors, a positive association with PVU was evident for longer time lapse after cancer diagnosis, chronic disease, and living with spouse/or partner, while cancer stage, educational achievement, and alcohol use were inversely associated PVU. On the other hand, multi-modality (≥ 3) cancer treatment was inversely associated with PVU only in elderly survivors. CONCLUSIONS PVU of Korean cancer survivors was suboptimal in younger survivors and non-lung cancer survivors. Factors associated with PVU differed between younger and elderly survivors, and more diverse factors were identified for younger survivors. IMPLICATIONS FOR CANCER SURVIVORS In order to promote adherence to PVU in cancer survivors, careful consideration of high-risk factors for non-immunization within cancer survivorship context would be necessary together with free-of-charge vaccination policy.
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Affiliation(s)
- Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyeonyoung Ko
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Eun Yoo
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, South Korea
| | - In Young Cho
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - BeLong Cho
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, South Korea
| | - Ji Eun Lee
- Department of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, South Korea
| | - JiHye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jungkwon Lee
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
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22
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Reed SC, Bell JF, Miglioretti DL, Nekhlyudov L, Fairman N, Joseph JG. Fear of cancer recurrence and associations with mental health status and individual characteristics among cancer survivors: Findings from a nationally representative sample. J Psychosoc Oncol 2019; 38:125-142. [PMID: 31510882 DOI: 10.1080/07347332.2019.1649338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: To describe the prevalence of fear of cancer recurrence (FCR) and test its associations with validated mental health status measures.Design: Cross-sectional survey using the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement.Sample: Post-treatment cancer survivors (n = 1032).Methods: Survey-weighted U.S. population-based estimates describe the prevalence of sociodemographic, health and mental health characteristics of cancer survivors by their level of FCR. Multinomial logistic regression was used to test associations of validated measures of mental health status and individual characteristics on levels of FCR in unadjusted models and those controlling for sociodemographic and health characteristics.Findings: Overall, 34.3% of cancer survivors reported no FCR, 54.4% reported low FCR, and 11.3% reported high FCR. Cancer survivors were at increased risk of reporting high FCR relative to no FCR if they had a low 12-item Short Form Health Survey Mental Component Summary score (≤48) compared to high scores (odds ratio = 2.88; 95% confidence interval = 1.57, 5.29). Reporting depressive symptoms or psychological distress did not significantly increase the risk of reporting high or low FCR relative to no FCR.Conclusions: To our knowledge, this study is the first to provide U.S. population-based estimates of associations between FCR and individual and health characteristics.Implications for Psychosocial Providers or Policy: Our results provide valuable information about which survivors are most at-risk for FCR. Future research is needed to more clearly differentiate FCR from other constructs.
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Affiliation(s)
- Sarah C Reed
- Betty Irene Moore School of Nursing, University of California, Sacramento, CA, USA
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Sacramento, CA, USA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Department of Medicine, Brigham and Women's Hospital, Boston, CA, USA
| | - Nathan Fairman
- UC Davis Comprehensive Cancer Center, Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Davis, CA, USA
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Sacramento, CA, USA
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23
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Josey MJ, Odahowski CL, Zahnd WE, Schootman M, Eberth JM. Disparities in Utilization of Medical Specialists for Colonoscopy. Health Equity 2019; 3:464-471. [PMID: 31501806 PMCID: PMC6729104 DOI: 10.1089/heq.2019.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: Colonoscopy is the preferred screening modality for colorectal cancer (CRC) prevention. The quality of the procedure varies although medical specialists such as gastroenterologists and colorectal surgeons tend to have better outcomes. We aimed to determine whether there are demographic and clinical differences between those who received a colonoscopy from a specialist versus those who received a colonoscopy from a nonspecialist. Methods: Using the population-based South Carolina Outpatient Ambulatory Surgery Database, we looked retrospectively to obtain patient-level endoscopy records from 2010 to 2014. We used multilevel logistic regression to model whether patients saw a specialist for their colonoscopy. The primary variables were patient race and insurance type, and an interaction by rurality was tested. Results: Of the 392,285 patients included in the analysis, 81% saw a specialist for their colonoscopy. County of residence explained 30% of the variability in the outcome. Non-Hispanic black (OR=0.65; confidence interval [95% CI]: 0.64–0.67) and Hispanic patients (OR=0.75; 95% CI: 0.67–0.84) were significantly less likely than non-Hispanic white patients to see a specialist. Compared with commercial/HMO insurance, all other types were less likely to see a specialist, and even more so for rural patients. The interaction of race by rurality was not significant. Conclusions: Specialists play a key role in CRC screening and can affect later downstream outcomes. This study has shown that ethnic minorities and adults with public or other insurance, particularly in rural areas, are most likely not to see a specialist. These results are consistent with disparities in CRC incidence, mortality, and survival.
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Affiliation(s)
- Michele J Josey
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
| | - Cassie L Odahowski
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
| | - Mario Schootman
- Department of Clinical Analytics and Insights, Center for Clinical Excellence, SSM Health System, St. Louis, Missouri
| | - Jan M Eberth
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.,Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
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24
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Moran RJ, Waalen J, Murphy J, Nalawade V, Schiaffino M. Pneumococcal Vaccination Utilization Among Hispanic Long-Term Colorectal Cancer Survivors: Cross-Sectional Assessment of Claims. JMIR Public Health Surveill 2019; 5:e12603. [PMID: 31094341 PMCID: PMC6535973 DOI: 10.2196/12603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 03/30/2019] [Indexed: 01/27/2023] Open
Abstract
Background Colorectal cancer (CRC) is the second leading cancer-related cause of death in the United States. However, survivorship has been increasing. Both cancer survivors and underserved populations experience unique health-related challenges and disparities that may exist among long-term CRC survivors as it relates to routine preventive care, specifically pneumococcal (PNM) vaccination. Objective The aim of this study was to explore the relationship between long-term CRC survival and the receipt of PNM vaccine among Hispanic Medicare recipients compared with non-Hispanic populations. Methods This study is a cross-sectional analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data examining ethnic differences in the receipt of PNM vaccination among long-term CRC survivors. Multivariable logistic regression models considered Hispanic ethnicity while controlling for sociodemographic characteristics, comorbidity score, age, tumor stage, and SEER registry. Results Our sample revealed 32,501 long-term CRC survivors, and 1509 identified as Hispanic (4.64%) based on an established SEER algorithm. In total, 16,252 CRC survivors, or 50.00% of our sample, received a PNM vaccination. We found that Hispanic CRC survivors had 10% decreased odds of having received a PNM vaccine compared with non-Hispanic survivors (P=.03). Conclusions Disparities likely exist in the utilization of PNM vaccination among long-term CRC survivors. Among Medicare beneficiaries, the use of claims data regarding PNM vaccination highlights the relatively poor utilization of guideline-directed preventive care.
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Affiliation(s)
- Ryan J Moran
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States.,School of Public Health, San Diego State University, San Diego, CA, United States
| | - Jill Waalen
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States.,3Scripps Translational Research Institute, San Diego, CA, United States
| | - James Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, United States
| | - Vinit Nalawade
- School of Public Health, San Diego State University, San Diego, CA, United States.,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, United States
| | - Melody Schiaffino
- School of Public Health, San Diego State University, San Diego, CA, United States.,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, United States
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25
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Everson N, Levett-Jones T, Pitt V, Lapkin S, Van Der Riet P, Rossiter R, Jones D, Gilligan C, Courtney Pratt H. Analysis of the Empathic Concern Subscale of the Emotional Response Questionnaire in a Study Evaluating the Impact of a 3D Cultural Simulation. Int J Nurs Educ Scholarsh 2018; 15:/j/ijnes.2018.15.issue-1/ijnes-2017-0003/ijnes-2017-0003.xml. [DOI: 10.1515/ijnes-2017-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/07/2018] [Indexed: 12/30/2022]
Abstract
AbstractAbstract Background Empathic concern has been found to decline in health professional students. Few effective educational programs and a lack of validated scales are reported. Previous analysis of the Empathic Concern scale of the Emotional Response Questionnaire has reported both one and two latent constructs. Aim To evaluate the impact of simulation on nursing students’ empathic concern and test the psychometric properties of the Empathic Concern scale. Methods The study used a one group pre-test post-test design with a convenience sample of 460 nursing students. Empathic concern was measured pre-post simulation with the Empathic Concern scale. Factor Analysis was undertaken to investigate the structure of the scale. Results There was a statistically significant increase in Empathic Concern scores between pre-simulation 5.57 (SD = 1.04) and post-simulation 6.10 (SD = 0.95). Factor analysis of the Empathic Concern scale identified one latent dimension. Conclusion Immersive simulation may promote empathic concern. The Empathic Concern scale measured a single latent construct in this cohort.
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Affiliation(s)
- Naleya Everson
- The University of Technology, Faculty of Health, Sydney, Australia
| | | | - Victoria Pitt
- Department of Nursing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Samuel Lapkin
- Centre for Research in Nursing and Health, St George Hospital, Kogorah, Australia
| | - Pamela Van Der Riet
- Department of Nursing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Rachel Rossiter
- Charles Sturt University, Albury, New South Wales, Australia
| | - Donovan Jones
- Department of Nursing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Conor Gilligan
- Department of Nursing, The University of Newcastle, Callaghan, New South Wales, Australia
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26
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Reed SC, Bell JF, Whitney R, Lash R, Kim KK, Bold RJ, Joseph JG. Psychosocial outcomes in active treatment through survivorship. Psychooncology 2017; 27:279-285. [PMID: 28429466 DOI: 10.1002/pon.4444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/26/2017] [Accepted: 04/14/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of the study is to understand potential differences in psychosocial outcomes from active treatment to survivorship. METHODS Using the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement (n = 1360), we examined and compared psychosocial outcomes among respondents in active treatment with survivors by year(s) since treatment ended. Survey-weighted regression models were used to test associations between year(s) since treatment and depressive symptoms (Patient Health Questionnaire-2), psychological distress (K6), and cancer-specific worry related to recurrence. RESULTS Unadjusted estimates showed no significant differences in depressive symptoms or psychological distress between those in active treatment and cancer survivors at any time posttreatment. In contrast, the prevalence of cancer-specific worry was lowest among survivors more than 5 years since treatment (10%), slightly higher among those with less than 1 year since treatment (15%), and highest among those in active treatment (32%). In models controlled for sociodemographic and health-related covariates, the year(s) since treatment ended was inversely associated with the odds of cancer-specific worry but was not associated with depressive symptoms or psychological distress. CONCLUSIONS In this population-based sample, worry about cancer recurrence may diminish with years since treatment ended, while depressive symptoms and distress are persistent across the trajectory. These findings highlight unmet psychosocial needs among cancer survivors and demonstrate the importance of targeted interventions across the survivorship continuum.
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Affiliation(s)
- Sarah C Reed
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA.,Collaborative Cancer Care Research Group, University of California, Davis, Sacramento, CA, USA.,Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, IL, USA
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA.,Collaborative Cancer Care Research Group, University of California, Davis, Sacramento, CA, USA
| | | | - Rebecca Lash
- Department of Nursing Practice, Research, and Education, UCLA Health System, Los Angeles, CA, USA
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA.,Collaborative Cancer Care Research Group, University of California, Davis, Sacramento, CA, USA
| | - Richard J Bold
- Collaborative Cancer Care Research Group, University of California, Davis, Sacramento, CA, USA.,Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, USA
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA.,Collaborative Cancer Care Research Group, University of California, Davis, Sacramento, CA, USA
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27
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Lu D, Qiao Y, Brown NE, Wang J. Racial and Ethnic Disparities in Influenza Vaccination among Adults with Chronic Medical Conditions Vary by Age in the United States. PLoS One 2017; 12:e0169679. [PMID: 28081234 PMCID: PMC5231366 DOI: 10.1371/journal.pone.0169679] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/20/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND People living with chronic health conditions exhibit higher risk for developing severe complications from influenza according to the Centers for Diseases Control and Prevention. Although racial and ethnic disparities in influenza vaccination have been documented, it has not been comprehensively determined whether similar disparities are present among the adult population with at least one such condition. OBJECTIVE To study if racial and ethnic disparities in relation to influenza vaccination are present in adults suffering from at least one chronic condition and if such inequalities differ between age groups. METHODS The Medical Expenditure Panel Survey (2011-2012) was used to study the adult population (age ≥18) who had at least one chronic health condition. Baseline differences in population traits across racial and ethnic groups were identified using a chi-square test. This was conducted among various age groups. In addition, survey logistic regression was utilized to produce odds ratios of receiving influenza vaccination annually between racial and ethnic groups. RESULTS The total sample consisted of 15,499 adults living with at least one chronic health condition. The numbers of non-Hispanic whites (whites), non-Hispanic blacks (blacks), and Hispanics were 8,658, 3,585, and 3,256, respectively. Whites (59.93%) were found to have a higher likelihood of self-reporting their receipt of the influenza vaccine in comparison to the black (48.54%) and Hispanic (48.65%) groups (P<0.001). When examining persons aged 50-64 years and ≥65 years, it was noted that the black (54.99%, 62.72%) and Hispanic (53.54%, 64.48%) population had lower rates of influenza vaccine coverage than the white population (59.22%, 77.89) (both P<0.0001). No significant differences between whites and the blacks or Hispanics were found among the groups among adults between 18 and 49 inclusive (P>0.05). After controlling for patient characteristics, the difference in influenza vaccine coverage between whites and the minority groups were no longer significant for adults aged 50-64 years. However, the difference were still statistically significant for those aged ≥65 years. CONCLUSIONS In the United States, there are significant disparities in influenza vaccination by race and ethnicity for adults over 65 years with at least one chronic health condition. Future research is needed to help develop more targeted interventions to address these issues and improve influenza vaccination rates.
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Affiliation(s)
- Degan Lu
- Department of Respiratory Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shangdong, China
| | - Yanru Qiao
- College of Pharmacy, University of Tennessee, Memphis, Tennessee, United States of America
| | - Natalie E. Brown
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Junling Wang
- College of Pharmacy, University of Tennessee, Memphis, Tennessee, United States of America
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28
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Wiley G, Piper A, Phyllis Butow AM, Schofield P, Douglas F, Roy J, Nolte L, Jefford M. Developing Written Information for Cancer Survivors from Culturally and Linguistically Diverse Backgrounds: Lessons Learnt. Asia Pac J Oncol Nurs 2017; 5:121-126. [PMID: 29379844 PMCID: PMC5763430 DOI: 10.4103/apjon.apjon_63_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Australia is a multicultural nation with a large migrant population. Migrants with cancer report inferior quality of life and the need for more information in their own language. This paper describes lessons learnt from developing culturally appropriate written information resources with and for Arabic, Italian, and Vietnamese cancer survivors and carers. The information needs of survivors from these language groups as well as guidelines for the development of written resources for culturally diverse populations were identified through literature review. Community consultation was undertaken with focus groups. The content was developed and tested with health professionals who spoke the appropriate language and focus group participants, ensuring relevance and appropriateness. Resource design and dissemination were informed through community consultation. A number of key tasks for developing resources were identified as follows: (1) community engagement and consultation; (2) culturally sensitive data collection; (3) focus group facilitators (recruitment and training); (4) content development; (5) translation and review process; (6) design; and (7) sustainability. This project reinforced literature review findings on the importance of cultural sensitivity in the development of resources. Engaging with community groups and incorporating culturally appropriate recruitment strategies optimises recruitment to focus groups and facilitates content development. Stakeholders and lay persons from the intended ethnic-minority communities should be involved in the development and formative evaluation of resources to ensure appropriateness and relevance and in the dissemination strategy to optimize penetration. We believe the lessons we have learnt will be relevant to any group intending to develop health information for culturally and linguistic diverse groups.
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Affiliation(s)
- Georgina Wiley
- Australian Cancer Survivorship Centre - A Richard Pratt Legacy, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amanda Piper
- Australian Cancer Survivorship Centre - A Richard Pratt Legacy, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A M Phyllis Butow
- Psycho-oncology Co-operative Research Group, The University of Sydney, Sydney, New South Wales, Australia
| | - Penny Schofield
- Department of Psychological Sciences, Swinburne University, Melbourne, Victoria, Australia
| | - Fiona Douglas
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jane Roy
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Linda Nolte
- Australian Cancer Survivorship Centre - A Richard Pratt Legacy, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre - A Richard Pratt Legacy, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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29
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de Moor JS, Virgo KS, Li C, Chawla N, Han X, Blanch-Hartigan D, Ekwueme DU, McNeel TS, Rodriguez JL, Yabroff KR. Access to Cancer Care and General Medical Care Services Among Cancer Survivors in the United States: An Analysis of 2011 Medical Expenditure Panel Survey Data. Public Health Rep 2016; 131:783-790. [PMID: 28123224 DOI: 10.1177/0033354916675852] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Cancer survivors require appropriate health care to manage their unique health needs. This study describes access to cancer care among cancer survivors in the United States and compares access to general medical care between cancer survivors and people who have no history of cancer. METHODS We assessed access to general medical care using the core 2011 Medical Expenditure Panel Survey (MEPS). We assessed access to cancer care using the MEPS Experiences With Cancer Survey. We used multivariable logistic regression to compare access to general medical care among 2 groups of cancer survivors (those who reported having access to all necessary cancer care [n = 1088] and those who did not [n = 70]) with self-reported access to general medical care among people who had no history of cancer (n = 22 434). RESULTS Of the 1158 cancer survivors, 70 (6.0%) reported that they did not receive all necessary cancer care. Adjusted analyses found that cancer survivors who reported not receiving all necessary cancer care were also less likely to report receiving general medical care (78.0%) than cancer survivors who reported having access to necessary cancer care (87.1%) and people who had no history of cancer (87.8%). CONCLUSIONS This study provides nationally representative data on the proportion of cancer survivors who have access to necessary cancer care and yields insight into factors that impede survivors' access to both cancer care and general medical care. This study is a reference for future work on access to care.
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Affiliation(s)
- Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Katherine S Virgo
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chunyu Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neetu Chawla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | | | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Juan L Rodriguez
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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30
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Cheruvu VK, Oancea S. Current depression as a potential barrier to health care utilization in adult cancer survivors. Cancer Epidemiol 2016; 44:132-137. [DOI: 10.1016/j.canep.2016.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 07/08/2016] [Accepted: 08/12/2016] [Indexed: 11/24/2022]
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31
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Almario CV, May FP, Maxwell AE, Ren W, Ponce NA, Spiegel BMR. Persistent racial and ethnic disparities in flu vaccination coverage: Results from a population-based study. Am J Infect Control 2016; 44:1004-9. [PMID: 27372226 DOI: 10.1016/j.ajic.2016.03.064] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Advisory Committee on Immunization Practices recommends annual flu vaccination for all adults. We aimed to identify predictors of receiving a flu vaccination, with an emphasis on the impact of race and ethnicity. METHODS We used data from the 2011-2012 California Health Interview Survey and included all individuals aged ≥18 years. We performed a survey-weighted logistic regression on receipt of flu vaccination within the last year, adjusted by demographic and socioeconomic variables, and calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Our study included a population-weighted sample of 27,796,484 individuals. Overall, 35.8% received a flu vaccination within the last year. Blacks were 33% less likely (95% CI, 21%-43%) to have been vaccinated than whites. Conversely, Koreans (OR, 1.77; 95% CI, 1.35-2.33) and Vietnamese (OR, 1.57; 95% CI, 1.19-2.07) were more likely than whites to have been vaccinated. No differences were seen between whites and the remaining racial and ethnic groups (Latino, Japanese, Chinese, Filipino, South Asian, Asian other, and other). CONCLUSIONS Racial and ethnic disparities in flu vaccination uptake exist in California. Namely, blacks have lower vaccination rates than whites, and there are disparate vaccination rates among the Asian-American subgroups. Efforts to increase vaccination rates among these groups are needed.
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Affiliation(s)
- Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA; Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Folasade P May
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA; Division of Digestive Diseases, Department of Medicine, UCLA, Los Angeles, CA
| | - Allison E Maxwell
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Wanmeng Ren
- UCLA Luskin School of Public Affairs, Los Angeles, CA
| | - Ninez A Ponce
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA; UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA; Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.
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Li J, Thompson TD, Richards TB, Steele CB. Racial and Ethnic Differences in Health Behaviors and Preventive Health Services Among Prostate Cancer Survivors in the United States. Prev Chronic Dis 2016; 13:E95. [PMID: 27442995 PMCID: PMC4956476 DOI: 10.5888/pcd13.160148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction Little is known about how health behaviors and receipt of preventive health care differ by race and ethnicity among prostate cancer survivors. The purpose of this study was to identify differences in the prevalence of 7 modifiable factors related to prostate cancer: smoking, alcohol consumption, physical inactivity, weight, colorectal cancer screening, influenza vaccination, and pneumococcal vaccination. Methods We used data from the 2010 Behavioral Risk Factor Surveillance System to calculate the racial/ethnic prevalence of sociodemographic and health-related characteristics, health behaviors, and preventive health care among prostate cancer survivors. Adjusted prevalence estimates were calculated by using multivariable logistic regression. Results We identified 8,016 men with a history of prostate cancer. Multivariable analyses indicated that more black men reported being obese (29.9%; 95% confidence interval [CI], 24.5%–35.9%) than white men (22.8%; 95% CI, 21.1%–24.6%). More white men (3.6%; 95% CI, 2.9%–4.5%) reported consuming more than 2 alcoholic drinks per day than black men (0.9%; 95% CI, 0.4%–2.0%). More white men aged 65 or older reported receiving pneumococcal vaccine (74.2%; 95% CI, 72.2%–76.1%) than black men of the same age (63.2%; 95% CI, 54.8%–70.8%).We did not observe any differences in the prevalence of health behaviors and preventive health care between white men and men in Hispanic or other race categories. Conclusion Differences in alcohol consumption, obesity, and receipt of pneumococcal vaccination existed only between black and white prostate cancer survivors. These differences underscore the need to develop culturally appropriate, evidence-based interventions to reduce excessive alcohol consumption, maintain a healthy weight, and promote pneumococcal vaccination among prostate cancer survivors.
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Affiliation(s)
- Jun Li
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Atlanta, GA 30341.
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Thomas B Richards
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - C Brooke Steele
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
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Baird KE. The financial burden of out-of-pocket expenses in the United States and Canada: How different is the United States? SAGE Open Med 2016; 4:2050312115623792. [PMID: 26985389 PMCID: PMC4778086 DOI: 10.1177/2050312115623792] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/18/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This article compares the burden that medical cost-sharing requirements place on households in the United States and Canada. It estimates the probability that individuals with similar demographic features in the two countries have large medical expenses relative to income. METHOD The study uses 2010 nationally representative household survey data harmonized for cross-national comparisons to identify individuals with high medical expenses relative to income. Using logistic regression, it estimates the probability of high expenses occurring among 10 different demographic groups in the two countries. RESULTS The results show the risk of large medical expenses in the United States is 1.5-4 times higher than it is in Canada, depending on the demographic group and spending threshold used. The United States compares least favorably when evaluating poorer citizens and when using a higher spending threshold. CONCLUSION Recent health care reforms can be expected to reduce Americans' catastrophic health expenses, but it will take very large reductions in out-of-pocket expenditures-larger than can be expected-if poorer and middle-class families are to have the financial protection from high health care costs that their counterparts in Canada have.
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Affiliation(s)
- Katherine E Baird
- The Division of Politics, Philosophy and Public Affairs, University of Washington Tacoma, Tacoma, WA, USA
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Lee M, Salloum RG. Racial and ethnic disparities in cost-related medication non-adherence among cancer survivors. J Cancer Surviv 2015; 10:534-44. [PMID: 26620816 DOI: 10.1007/s11764-015-0499-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer survivors are delaying or avoiding necessary care due to costs, and medication non-adherence is an important aspect of deferred treatment. This study estimates the prevalence of cost-related medication non-adherence (CRN) by race and ethnicity and examines factors associated with CRN among cancer survivors. METHODS Using the 2006-2013 National Health Interview Survey, we examine self-reported CRN among cancer survivors compared with cancer-free controls. Descriptive statistics and multiple logistic regression models were used to identify factors associated with CRN among cancer survivors. RESULTS In a nationally representative sample of 472,542 adults, 10,998 participants reported a history of cancer and 461,544 did not. Among 10,998 cancer survivors, 1397 (12.70 %) reported CRN. Among older cancer survivors, African-Americans were 2.64 times more likely (95 % confidence interval (CI), 1.73 to 4.01) and Hispanics 2.07 times more likely (95 % CI, 1.32 to 3.24) than whites to report CRN. Among younger cancer survivors, Hispanics were 1.61 times more likely (95 % CI, 1.23 to 2.10) than whites to report CRN. CONCLUSIONS Significant racial and ethnic disparities in CRN were evident among cancer survivors. Older African-American and Hispanic overall survivors were more likely to report CRN in the past year compared with non-Hispanic whites. IMPLICATIONS FOR CANCER SURVIVORS Given increasing prescription drug expenditure, it is important to closely monitor CRN in high-risk subgroups. Racial and ethnic minority groups at high risk for CRN should be counseled on the importance of medication adherence and offered support services to promote medication adherence. Further studies are warranted to establish effective policies and interventions in vulnerable populations.
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Affiliation(s)
- Minjee Lee
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Ojha RP, Offutt-Powell TN, Gurney JG. Influenza vaccination coverage among adult survivors of pediatric cancer. Am J Prev Med 2014; 46:552-8. [PMID: 24842731 DOI: 10.1016/j.amepre.2014.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/23/2013] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A large proportion of long-term survivors of childhood cancer have treatment-related adverse cardiac and pulmonary late-effects, with related mortality. Consequently, this population of approximately 379,000 individuals in the U.S. is at high risk of complications from influenza infections. PURPOSE To estimate influenza vaccination coverage overall and among subgroups of adult survivors of pediatric cancer aged 18-64 years and to compare coverage with the general adult U.S. population. METHODS Data from the 2009 Behavioral Risk Factor Surveillance System were analyzed in 2013 using binomial regression to estimate influenza vaccination coverage differences (CDs) and corresponding 95% confidence limits (CLs) between adult survivors of pediatric cancer and the general U.S. population. Analyses were stratified by demographic characteristics and adjusted for design effects, non-coverage, and non-response. RESULTS Influenza vaccination coverage was 37% for adult pediatric cancer survivors overall and 31% for the general adult U.S. population (CD=6.3%, 95% CL=0.04%, 13%). Dramatically lower coverage was observed for non-Hispanic black survivors (6%) than for non-Hispanic blacks in the general U.S. population (26%; CD=-18%, 95% CL=-25%, -11%). CONCLUSIONS Although influenza vaccination coverage was modestly higher among adult survivors of pediatric cancer than the general U.S. population, coverage was less than desirable for a population with a high prevalence of cardiopulmonary conditions and early mortality, and far lower than the Healthy People 2010 goal of 60% or Healthy People 2020 goal of 80% for the general population.
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Affiliation(s)
- Rohit P Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Tabatha N Offutt-Powell
- Office of Infectious Disease Epidemiology, Division of Public Health, Delaware Health and Social Services, Dover, Delaware
| | - James G Gurney
- Department of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, Tennessee
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Watanabe-Galloway S, Zhang W, Watkins K, Islam KM, Nayar P, Boilesen E, Lander L, Wang H, Qiu F. Quality of End-of-Life Care Among Rural Medicare Beneficiaries With Colorectal Cancer. J Rural Health 2014; 30:397-405. [DOI: 10.1111/jrh.12074] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shinobu Watanabe-Galloway
- Department of Epidemiology; College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Wanqing Zhang
- Department of Allied Health Sciences; School of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Kate Watkins
- Department of Epidemiology; College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - KM Islam
- Department of Health Services Research and Administration; College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Preethy Nayar
- Department of Health Services Research and Administration; College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Eugene Boilesen
- Center for Collaboration on Research Design and Analysis; College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Lina Lander
- Department of Epidemiology; College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Hongmei Wang
- Department of Health Services Research and Administration; College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Fang Qiu
- Department of Biostatistics; College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
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van Ryn M, Phelan SM, Arora NK, Haggstrom DA, Jackson GL, Zafar SY, Griffin JM, Zullig LL, Provenzale D, Yeazel MW, Jindal RM, Clauser SB. Patient-reported quality of supportive care among patients with colorectal cancer in the Veterans Affairs Health Care System. J Clin Oncol 2014; 32:809-15. [PMID: 24493712 PMCID: PMC3940539 DOI: 10.1200/jco.2013.49.4302] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer. PATIENTS AND METHODS Patients with new diagnosis of colorectal cancer at any Veterans Health Administration medical center nationwide in 2008 were ascertained through the Veterans Affairs Central Cancer Registry and sent questionnaires assessing a variety of aspects of patient-centered cancer care. We received questionnaires from 63% of eligible patients (N = 1,109). Descriptive analyses characterizing patient experiences with supportive care and binary logistic regression models were used to examine predictors of receipt of help wanted for each of the five symptom categories. RESULTS There were significant gaps in patient-centered quality of supportive care, beginning with symptom assessment. In multivariable modeling, the impact of clinical factors and patient race on odds of receiving wanted help varied by symptom. Coordination of care quality predicted receipt of wanted help for all symptoms, independent of patient demographic or clinical characteristics. CONCLUSION This study revealed substantial gaps in patient-centered quality of care, difficult to characterize through quality measurement relying on medical record review alone. It established the feasibility of collecting patient-reported quality measures. Improving quality measurement of supportive care and implementing patient-reported outcomes in quality-measurement systems are high priorities for improving the processes and outcomes of care for patients with cancer.
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Affiliation(s)
- Michelle van Ryn
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Sean M. Phelan
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Neeraj K. Arora
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - David A. Haggstrom
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - George L. Jackson
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - S. Yousuf Zafar
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Joan M. Griffin
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Leah L. Zullig
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Dawn Provenzale
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Mark W. Yeazel
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Rahul M. Jindal
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
| | - Steven B. Clauser
- Michelle van Ryn and Sean M. Phelan, Mayo Clinic, Rochester; Joan M. Griffin, Veterans Affairs Medical Center; Mark W. Yeazel, University of Minnesota, Minneapolis, MN; Neeraj K. Arora and Steven B. Clauser, National Cancer Institute, Bethesda, MD; David A. Haggstrom, Roudebush Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, IN; George L. Jackson, Leah L. Zullig, and Dawn Provenzale, Durham Veterans Affairs Medical Center; George L. Jackson, S. Yousuf Zafar, and Dawn Provenzale, Duke University Medical Center, Durham; Leah L. Zullig, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Rahul M. Jindal, Walter Reed Army Medical Center, Washington, DC
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