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Nechuta S, Chen WY, Goerge A, Boopathy D, Sanderson M. The role of breast cancer-related arm lymphedema in physical functioning and physical activity participation among long-term African American breast cancer survivors. Support Care Cancer 2024; 32:446. [PMID: 38900224 DOI: 10.1007/s00520-024-08648-3] [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: 02/14/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Breast cancer-related arm lymphedema (BCRL) is a common chronic and debilitating condition that involves accumulation of lymphatic fluid in the arm or hand. Limited data are available on BCRL in African American women. Lack of physical activity (PA) and poor physical functioning (PF) are both associated with increased morbidity and mortality among breast cancer survivors. We examined the association of BCRL with PA and PF among African American breast cancer survivors. METHODS 323 African American women who previously participated in a case-only study in three states (TN, GA, SC) completed a survivorship-focused questionnaire (mean: 4.2 years post-diagnosis) in 2015-2016. Validated measures were used to determine BCRL, PF, and PA. Adjusted binary logistic regression models estimated ORs and 95% CIs for the association of BCRL and meeting PA guidelines (≥ 150 min/week), while multinomial logistic regression was used for PF and PA (minutes/week) categorized based on tertiles. RESULTS Approximately 32% reported BCRL since diagnosis; 25.4% reported BCRL in the last 12-months. About 26% and 50% reported that BCRL interfered with exercise and ability to do daily activities, respectively. The mean PF among those with BCRL was 51.0(SD:29.0) vs. 68.5(SD:30.1) among those without BCRL. BCRL was associated with lower PF (adjusted-OR for tertile 2: 2.12(95% CI:1.03-4.36) and adjusted-OR for tertile 1: 2.93(95% CI:1.44-5.96)). CONCLUSIONS BCRL was associated with lower PF among long-term African American breast cancer survivors. Continued monitoring by health care professionals and increased education and behavioral interventions to support PA and improved PF among survivors living with BCRL are warranted.
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Affiliation(s)
- Sarah Nechuta
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA.
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Deptartment of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Ally Goerge
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA
| | - Deepika Boopathy
- School of Interdisciplinary Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, USA
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Maureen Sanderson
- School of Medicine, Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, USA
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Gaur P, Ganguly AP, Kuo M, Martin R, Alvarez KS, Bhavan KP, Kho KA. Childcare needs as a barrier to healthcare among women in a safety-net health system. BMC Public Health 2024; 24:1608. [PMID: 38886715 PMCID: PMC11181530 DOI: 10.1186/s12889-024-19125-1] [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: 09/21/2023] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Childcare needs are an understudied social determinant of health. The effect of childcare needs on access to healthcare must be understood to inform health system interventions and policy reform. This study sought to characterize childcare needs, access to childcare, and prior experience with navigating childcare needs in healthcare settings among women in a safety-net population. METHODS We conducted a cross-sectional study of patient-reported survey data collected in-person between April and October 2019. Surveys were administered in waiting rooms of ambulatory services in a large, urban safety-net health system in Dallas, Texas. Survey respondents were derived from a random convenience sample of women waiting for outpatient appointments. Participants were screened for having children under the age of 13 and/or childcare responsibilities for inclusion in the sample. Outcomes of interest included self-reported delayed or missed care, reasons for delayed or missed care, perceived difficulty in accessing childcare, prior methods for managing childcare during healthcare appointments, and prior experience with childcare centers. RESULTS Among the 336 respondents (96.7% response rate), 121 (36.0%) reported delaying or missing a mean 3.7 appointments/year. Among women with delayed or missed care, 54.5% reported childcare barriers as the primary reason for deferral of care, greater than transportation (33%) or insurance (25%) barriers. Respondents rated childcare access as more difficult than healthcare access. Delayed or missed care due to childcare was more common among White (68.8%) and Black (55.0%) women compared to Hispanic women (34.3%). Common methods of navigating childcare needs during scheduled appointments included bringing children to appointments (69.1%) and re-scheduling or missing the scheduled appointment (43.0%). 40.6% of patients reported leaving an appointment before completion due to childcare needs. CONCLUSIONS Childcare needs are a leading barrier to healthcare among women accessing care in safety-net settings. Unmet childcare needs result in deferral of care, which may impact health outcomes. Childcare access is perceived as more challenging than healthcare access itself. Health system and policy interventions are needed to address childcare as a social determinant of health.
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Affiliation(s)
- Priyanka Gaur
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Anisha P Ganguly
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, United States of America.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
- Parkland Health Center for Innovation and Value at Parkland, 5200 Harry Hines Blvd, Dallas, TX, 75235, USA.
| | - Madyson Kuo
- Department of Obstetrics and Gynecology, Methodist Health System, Dallas, TX, United States of America
| | - Robert Martin
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, United States of America
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kristin S Alvarez
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, United States of America
| | - Kavita P Bhavan
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Kimberly A Kho
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
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Fram J, Boss K, Villaflor V, Jayabalan P. Barriers to and enablers of physical activity participation in lung cancer survivors. PM R 2024. [PMID: 38874321 DOI: 10.1002/pmrj.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Although physical activity physical activity has been shown to have significant benefits for individuals living with cancer, engaging lung cancer survivors (LCS) in increasing routine physical activity participation has been particularly challenging. PURPOSE To describe enablers of, barriers to, and patterns of physical activity among LCS and to characterize interest in a physical activity program as a first step to improving physical activity engagement. METHODS The study consisted of a cross-sectional survey (n = 100) of adult LCS recruited from a thoracic oncology clinic assessing multiple domains of physical activity (engagement, perceived barriers, benefits, physical function, psychosocial factors, self-efficacy, and programmatic preferences). RESULTS Only 12% of LCS in our cohort (average age 67 years, 54% male, 81% with stage III or IV disease) met American College of Sports Medicine (ACSM) physical activity guidelines. Participants engaged in moderate-to-vigorous physical activity, with an average (SD) of 48.4 (91.8) minutes per week. The most commonly reported barriers to physical activity were fatigue (49%), dyspnea (39%), and difficulty with daily activities (34%). Regression analysis demonstrated a positive association between moderate-to-vigorous physical activity and higher income (r = 0.241, p = .016), physical function (r = 0.281, p = .005), and physical activity self-efficacy (r = 0.270, p = .007). Qualitative results demonstrated a strong interest in physical activity programming that is lung-cancer specific with a high level of support and guidance. CONCLUSION This study identified that LCS had low levels of physical activity with fatigue, dyspnea, socioeconomic, and functional limitations contributing. The majority of LCS are interested in an exercise program and believe that exercise engagement will produce functional benefits. The present study presents a framework to guide development of community-based interventions to increase LCS physical activity participation among LCS.
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Affiliation(s)
- Julia Fram
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Victoria Villaflor
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Prakash Jayabalan
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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Torres-Perez AC, Ramos-Lopez WA, Covarrubias-Gómez A, Sánchez-Roman S, Quiroz-Friedman P, Alcocer-Castillejos N, Milke-García MDP, Carrillo-Soto M, Morales-Alfaro A, Chávarri-Guerra Y, Soto-Perez-de-Celis E. Supportive care needs among older Mexican adults with metastatic cancer. J Geriatr Oncol 2024; 15:101796. [PMID: 38761773 DOI: 10.1016/j.jgo.2024.101796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/18/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.
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Affiliation(s)
- Ana Cristina Torres-Perez
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Wendy Alicia Ramos-Lopez
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Alfredo Covarrubias-Gómez
- Department of Palliative Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Sofía Sánchez-Roman
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Paulina Quiroz-Friedman
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Natasha Alcocer-Castillejos
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Del Pilar Milke-García
- Department of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Mónica Carrillo-Soto
- Department of Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Andrea Morales-Alfaro
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yanin Chávarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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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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Burus T, Thompson JR, McAfee CR, Williams LB, Knight JR, Huang B, Kanotra S, Wilhite NP, Russell E, Rogers M, Sorrell CL, Stroebel C, King R, Hull PC. A framework and process for community-engaged, mixed-methods cancer needs assessments. Cancer Causes Control 2024:10.1007/s10552-024-01892-2. [PMID: 38809305 DOI: 10.1007/s10552-024-01892-2] [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: 10/16/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Community health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky. METHODS We convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities. RESULTS The resulting CNA has helped guide strategic planning and priorities for Kentucky's Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations. CONCLUSION This framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.
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Affiliation(s)
- Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
- University of Kentucky Markey Cancer Center, 760 Press Avenue, Suite 460, Lexington, KY, 40536, USA.
| | | | - Caree R McAfee
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Lovoria B Williams
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Jennifer Redmond Knight
- Kentucky Cancer Consortium, Lexington, KY, USA
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Bin Huang
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY, USA
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | | | | | - Elaine Russell
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Kentucky Cancer Consortium, Lexington, KY, USA
| | - Melinda Rogers
- Kentucky Cancer Program, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Connie L Sorrell
- Kentucky Cancer Program, Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | | | | | - Pamela C Hull
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
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Bourgeois A, Horrill T, Mollison A, Stringer E, Lambert LK, Stajduhar K. Barriers to cancer treatment for people experiencing socioeconomic disadvantage in high-income countries: a scoping review. BMC Health Serv Res 2024; 24:670. [PMID: 38807237 PMCID: PMC11134650 DOI: 10.1186/s12913-024-11129-2] [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: 09/12/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Despite advances in cancer research and treatment, the burden of cancer is not evenly distributed. People experiencing socioeconomic disadvantage have higher rates of cancer, later stage at diagnoses, and are dying of cancers that are preventable and screen-detectable. However, less is known about barriers to accessing cancer treatment. METHODS We conducted a scoping review of studies examining barriers to accessing cancer treatment for populations experiencing socioeconomic disadvantage in high-income countries, searched across four biomedical databases. Studies published in English between 2008 and 2021 in high-income countries, as defined by the World Bank, and reporting on barriers to cancer treatment were included. RESULTS A total of 20 studies were identified. Most (n = 16) reported data from the United States, and the remaining included publications were from Canada (n = 1), Ireland (n = 1), United Kingdom (n = 1), and a scoping review (n = 1). The majority of studies (n = 9) focused on barriers to breast cancer treatment. The most common barriers included: inadequate insurance and financial constraints (n = 16); unstable housing (n = 5); geographical distribution of services and transportation challenges (n = 4); limited resources for social care needs (n = 7); communication challenges (n = 9); system disintegration (n = 5); implicit bias (n = 4); advanced diagnosis and comorbidities (n = 8); psychosocial dimensions and contexts (n = 6); and limited social support networks (n = 3). The compounding effect of multiple barriers exacerbated poor access to cancer treatment, with relevance across many social locations. CONCLUSION This review highlights barriers to cancer treatment across multiple levels, and underscores the importance of identifying patients at risk for socioeconomic disadvantage to improve access to treatment and cancer outcomes. Findings provide an understanding of barriers that can inform future, equity-oriented policy, practice, and service innovation.
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Affiliation(s)
- Amber Bourgeois
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada.
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada.
| | - Tara Horrill
- College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Ashley Mollison
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada
| | - Eleah Stringer
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
| | - Leah K Lambert
- BC Cancer, Nursing and Allied Health Research and Knowledge Translation, 686 West Broadway, Vancouver, BC, V5Z 1G1, Canada
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall T201, Vancouver, BC, V6T 2B5, Canada
| | - Kelli Stajduhar
- Institute for Aging & Lifelong Health, University of Victoria, PO Box 1700, Victoria, BC, V8V 2Y2, Canada
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Siegel RD, LeFebvre KB, Temin S, Evers A, Barbarotta L, Bowman RM, Chan A, Dougherty DW, Ganio M, Hunter B, Klein M, Miller TP, Mulvey TM, Ouzts A, Polovich M, Salazar-Abshire M, Stenstrup EZ, Sydenstricker CM, Tsai S, Oslen MM. Antineoplastic Therapy Administration Safety Standards for Adult and Pediatric Oncology: ASCO-ONS Standards. JCO Oncol Pract 2024:OP2400216. [PMID: 38776491 DOI: 10.1200/op.24.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To update the ASCO-Oncology Nursing Society (ONS) standards for antineoplastic therapy administration safety in adult and pediatric oncology and highlight current standards for antineoplastic therapy for adult and pediatric populations with various routes of administration and location. METHODS ASCO and ONS convened a multidisciplinary Expert Panel with representation of multiple organizations to conduct literature reviews and add to the standards as needed. The evidence base was combined with the opinion of the ASCO-ONS Expert Panel to develop antineoplastic safety standards and guidance. Public comments were solicited and considered in preparation of the final manuscript. RESULTS The standards presented here include clarification and expansion of existing standards to include home administration and other changes in processes of ordering, preparing, and administering antineoplastic therapy; the advent of immune effector cellular therapy; the importance of social determinants of health; fertility preservation; and pregnancy avoidance. In addition, the standards have added a fourth verification. STANDARDS Standards are provided for which health care organizations and those involved in all aspects of patient care can safely deliver antineoplastic therapy, increase the quality of care, and reduce medical errors.Additional information is available at www.asco.org/standards and www.ons.org/onf.
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Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Amy Evers
- University of Pennsylvania Health System, Philadelphia, PA
| | - Lisa Barbarotta
- Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT
| | - Ronda M Bowman
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Alexandre Chan
- University of California, Irvine, Chao Family Comprehensive Cancer Center, National Cancer Centre Singapore, Irvine, CA
| | | | - Michael Ganio
- ASHP (American Society of Health-System Pharmacists), Bethesda, MD
| | | | - Meredith Klein
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Tamara P Miller
- Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | - Maritza Salazar-Abshire
- Department of Nursing Education, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Susan Tsai
- Ohio State University Comprehensive Cancer Center, Columbus, OH
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Hao S, Quinn AW, Iasiello JA, Lea CS, Popowicz P, Fu Y, Irish W, Parikh AA, Snyder RA. Correlation of Patient-Reported Social Determinants of Health With Census Tract Measures of Socioeconomic Disadvantage in Patients With GI Cancers in Eastern North Carolina. JCO Oncol Pract 2024:OP2300703. [PMID: 38759124 DOI: 10.1200/op.23.00703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Investigating the impact of social determinants of health (SDOHs) on cancer care in large populations relies on census estimates. Routine clinic SDOH screening provides timely patient-level information which could inform best practices. This study evaluated the correlation between patient-reported SDOH needs and population-level census tract measures. METHODS This was a retrospective cross-sectional study of a cohort of adult patients with GI malignancy screened for SDOHs such as financial insecurity, transportation, and food insecurity during initial outpatient evaluation at East Carolina University (formerly Vidant) Health Medical Center in Greenville, NC (November 2020-July 2021). Primary outcomes included number and severity of identified SDOH needs and area deprivation index (ADI) and census tract measures for each patient. Spearman rank correlations were calculated among patient-level needs and between patient-level needs and similar census tract measures. RESULTS Of 112 patients screened, 58.9% self-identified as White (n = 66) and 41.1% as Black (n = 46). A total of 50.5% (n = 54) resided in a rural county. The collective median state ADI rank was 7 (IQR, 5-9). The median household income was $38,125 in US dollars (USD) (IQR, $31,436-$48,934 [USD]). Only 12.5% (n = 14) reported a moderate or severe financial need. Among reported needs, financial need moderately correlated with food insecurity (coefficient, 0.46; P < .001) and transportation (coefficient, 0.45; P < .001). Overall, census tract measures and reported needs poorly correlated. Lack of transportation correlated with percentage of households without a vehicle (coefficient, 0.18; P = .03) and limited access to healthy foods (coefficient, 0.18; P = .04). CONCLUSION Given the poor correlation between reported and census needs, population-level measures may not accurately predict patient-reported needs. These findings highlight the importance of SDOH screening in the clinical setting to reduce health disparities and identify opportunities to improve care delivery.
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Affiliation(s)
- Scarlett Hao
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Ashley W Quinn
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - John A Iasiello
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - C Suzanne Lea
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Patrycja Popowicz
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Yuanyuan Fu
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - William Irish
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Alexander A Parikh
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Division of Surgical Oncology, University of Texas Health San Antonio, San Antonio, TX
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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10
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Cruz S, Lu C, Ulloa M, Redding A, Hester J, Jacobs M. Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study. JMIR Mhealth Uhealth 2024; 12:e50826. [PMID: 38717816 PMCID: PMC11112471 DOI: 10.2196/50826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low-socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. OBJECTIVE This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. METHODS We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. RESULTS Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. CONCLUSIONS The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices.
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Affiliation(s)
- Stefany Cruz
- Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Claire Lu
- Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Mara Ulloa
- Department of Computer Science, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Alexander Redding
- Department of Computer Science and Engineering, Irwin & Joan Jacobs School of Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Josiah Hester
- Interactive Computing and Computer Science, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Maia Jacobs
- Department of Computer Science, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
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11
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Keruakous AR, Akpan I, Chahin M, Kirolos A, Keruakous M. Equity in oncology care: addressing disparities in cancer treatment in Georgia. Front Public Health 2024; 12:1381075. [PMID: 38756877 PMCID: PMC11098010 DOI: 10.3389/fpubh.2024.1381075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
This research delves into the disparities in access to oncology care among cancer patients in Georgia, with a specific focus on the distinct challenges faced by African American (AA) individuals compared to non-African American (Non-AA) counterparts. Leveraging data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) survey and supplementary online resources, the study meticulously examines socioeconomic factors, including income, education, and insurance coverage, which significantly influence the quality of cancer care received. The analysis reveals substantial income gaps between AA and Non-AA patients, underscoring the critical implications for healthcare access. Moreover, AA patients exhibit lower rates of full insurance coverage for cancer-related treatments, posing additional barriers to comprehensive care. By investigating the intersections of race, income, and education, the research aims to pinpoint the root causes of these disparities and proposes evidence-based solutions to address the identified challenges. The ultimate objective is to contribute valuable insights that inform targeted policy recommendations and community-based interventions, fostering a more equitable landscape for oncology care in Georgia. This study seeks to amplify awareness and advocate for tangible measures, striving toward healthcare equity for all cancer patients, irrespective of their racial or socioeconomic backgrounds.
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Affiliation(s)
- Amany R. Keruakous
- Hematology Oncology Department, Georgia Cancer Center, Wellstar MCG Health, Augusta, GA, United States
| | | | - Michael Chahin
- Hematology Oncology Department, Georgia Cancer Center, Wellstar MCG Health, Augusta, GA, United States
| | | | - Mai Keruakous
- Mercer County Community College, Trenton, NJ, United States
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12
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Dantas AAG, de Oliveira NPD, Costa GAB, Martins LFL, Dos Santos JEM, Migowski A, de Camargo Cancela M, de Souza DLB. Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis. Sci Rep 2024; 14:9667. [PMID: 38671078 PMCID: PMC11053035 DOI: 10.1038/s41598-024-60449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.
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Affiliation(s)
| | | | - Guilherme Augusto Barcello Costa
- Graduate Program in Oncology, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Luís Felipe Leite Martins
- Surveillance and Situation Analysis Division, Prevention and Surveillance Coordination (CONPREV), National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Jonas Eduardo Monteiro Dos Santos
- Surveillance and Situation Analysis Division, Prevention and Surveillance Coordination (CONPREV), National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Arn Migowski
- Epidemiology Unit. Education and Research Coordination, National Institute of Cardiology (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
- Prevention and Surveillance Coordination (CONPREV), National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Marianna de Camargo Cancela
- Graduate Program in Oncology, Research and Innovation Coordination, National Cancer Institute (INCA), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Dyego Leandro Bezerra de Souza
- Graduate Program in Public Health, Federal University of Rio Grande do Norte - UFRN, Natal, RN, Brazil.
- Methodology, Methods, Models and Results in Health and Social Sciences Research Group (M3O), Faculty of Health Sciences and Well-Being. Health and Social Care Research Center (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.
- Public Health Department, Graduate Program in Public Health, Federal University of Rio Grande do Norte, 1787 Senador Salgado Filho Ave., Lagoa Nova, Natal, RN, 59010-000, Brazil.
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13
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Miller JW, King JA, Trivers KF, Town M, Sabatino SA, Puckett M, Richardson LC. Vital Signs: Mammography Use and Association with Social Determinants of Health and Health-Related Social Needs Among Women - United States, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:351-357. [PMID: 38652735 PMCID: PMC11037433 DOI: 10.15585/mmwr.mm7315e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Introduction Approximately 40,000 U.S. women die from breast cancer each year. Mammography is recommended to screen for breast cancer and reduce breast cancer mortality. Adverse social determinants of heath (SDOH) and health-related social needs (HRSNs) (e.g., lack of transportation and social isolation) can be barriers to getting mammograms. Methods Data from the 2022 Behavioral Risk Factor Surveillance System were analyzed to estimate the prevalence of mammography use within the previous 2 years among women aged 40-74 years by jurisdiction, age group, and sociodemographic factors. The association between mammography use and measures of SDOH and HRSNs was assessed for jurisdictions that administered the Social Determinants and Health Equity module. Results Among women aged 50-74 years, state-level mammography use ranged from 64.0% to 85.5%. Having health insurance and a personal health care provider were associated with having had a mammogram within the previous 2 years. Among women aged 50-74 years, mammography prevalence was 83.2% for those with no adverse SDOH and HRSNs and 65.7% for those with three or more adverse SDOH and HRSNs. Life dissatisfaction, feeling socially isolated, experiencing lost or reduced hours of employment, receiving food stamps, lacking reliable transportation, and reporting cost as a barrier for access to care were all strongly associated with not having had a mammogram within the previous 2 years. Conclusions and Implications for Public Health Practice Identifying specific adverse SDOH and HRSNs that women experience and coordinating activities among health care providers, social services, community organizations, and public health programs to provide services that help address these needs might increase mammography use and ultimately decrease breast cancer deaths.
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14
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Ameri P, Bertero E, Lombardi M, Porto I, Canepa M, Nohria A, Vergallo R, Lyon AR, López-Fernández T. Ischaemic heart disease in patients with cancer. Eur Heart J 2024; 45:1209-1223. [PMID: 38323638 DOI: 10.1093/eurheartj/ehae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
Cardiologists are encountering a growing number of cancer patients with ischaemic heart disease (IHD). Several factors account for the interrelationship between these two conditions, in addition to improving survival rates in the cancer population. Established cardiovascular (CV) risk factors, such as hypercholesterolaemia and obesity, predispose to both IHD and cancer, through specific mechanisms and via low-grade, systemic inflammation. This latter is also fuelled by clonal haematopoiesis of indeterminate potential. Furthermore, experimental work indicates that IHD and cancer can promote one another, and the CV or metabolic toxicity of anticancer therapies can lead to IHD. The connections between IHD and cancer are reinforced by social determinants of health, non-medical factors that modify health outcomes and comprise individual and societal domains, including economic stability, educational and healthcare access and quality, neighbourhood and built environment, and social and community context. Management of IHD in cancer patients is often challenging, due to atypical presentation, increased bleeding and ischaemic risk, and worse outcomes as compared to patients without cancer. The decision to proceed with coronary revascularization and the choice of antithrombotic therapy can be difficult, particularly in patients with chronic coronary syndromes, necessitating multidisciplinary discussion that considers both general guidelines and specific features on a case by case basis. Randomized controlled trial evidence in cancer patients is very limited and there is urgent need for more data to inform clinical practice. Therefore, coexistence of IHD and cancer raises important scientific and practical questions that call for collaborative efforts from the cardio-oncology, cardiology, and oncology communities.
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Affiliation(s)
- Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Edoardo Bertero
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Marco Lombardi
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Roma, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rocco Vergallo
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | | | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
- Cardiology Department, Quirón Pozuelo University Hospital, Madrid, Spain
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15
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Graboyes EM, Lee SC, Lindau ST, Adams AS, Adjei BA, Brown M, Sadigh G, Incudine A, Carlos RC, Ramsey SD, Bangs R. Interventions addressing health-related social needs among patients with cancer. J Natl Cancer Inst 2024; 116:497-505. [PMID: 38175791 DOI: 10.1093/jnci/djad269] [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: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
Health-related social needs are prevalent among cancer patients; associated with substantial negative health consequences; and drive pervasive inequities in cancer incidence, severity, treatment choices and decisions, and outcomes. To address the lack of clinical trial evidence to guide health-related social needs interventions among cancer patients, the National Cancer Institute Cancer Care Delivery Research Steering Committee convened experts to participate in a clinical trials planning meeting with the goal of designing studies to screen for and address health-related social needs among cancer patients. In this commentary, we discuss the rationale for, and challenges of, designing and testing health-related social needs interventions in alignment with the National Academy of Sciences, Engineering, and Medicine 5As framework. Evidence for food, housing, utilities, interpersonal safety, and transportation health-related social needs interventions is analyzed. Evidence regarding health-related social needs and delivery of health-related social needs interventions differs in maturity and applicability to cancer context, with transportation problems having the most maturity and interpersonal safety the least. We offer practical recommendations for health-related social needs interventions among cancer patients and the caregivers, families, and friends who support their health-related social needs. Cross-cutting (ie, health-related social needs agnostic) recommendations include leveraging navigation (eg, people, technology) to identify, refer, and deliver health-related social needs interventions; addressing health-related social needs through multilevel interventions; and recognizing that health-related social needs are states, not traits, that fluctuate over time. Health-related social needs-specific interventions are recommended, and pros and cons of addressing more than one health-related social needs concurrently are characterized. Considerations for collaborating with community partners are highlighted. The need for careful planning, strong partners, and funding is stressed. Finally, we outline a future research agenda to address evidence gaps.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Cancer Center, University of Kansas, Kansas City, KS, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA
| | - Alyce S Adams
- Departments of Health Policy/Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Office of Cancer Health Equity and Community Engagement, Stanford Cancer Institute, Stanford Medicine, Stanford, CA, USA
| | - Brenda A Adjei
- Office of the Associate Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Mary Brown
- Adena Cancer Center, Hematology and Oncology, Chillicothe, OH, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
| | | | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Scott D Ramsey
- Department of Pharmacy, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Rick Bangs
- SWOG Cancer Research Network, Portland, OR, USA
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16
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Jeong S, Choi YJ. Association between Socioecological Status, Nutrient Intake, and Cancer Screening Behaviors in Adults Aged 40 and Over: Insights from the Eighth Korea National Health and Nutrition Examination Survey (KNHANES, 2019). Nutrients 2024; 16:1048. [PMID: 38613081 PMCID: PMC11013844 DOI: 10.3390/nu16071048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer screening is pivotal for early detection and improved survival rates. While socio-ecological factors are known to influence screening uptake, the role of lifestyle, dietary habits, and general health in shaping these decisions remains underexplored. Utilizing the 2019 Korea National Health and Nutrition Examination Survey (KNHANES), this study examined the myriad of factors impacting cancer screening utilization. Data from 274,872 adults aged 40 years or older were scrutinized, highlighting demographics, income, lifestyle behaviors, health-related variables, nutrient intake, and dietary quality. A combination of descriptive statistics and logistic regression helped us ascertain influential determinants. Higher educational attainment and income quartiles were positively correlated with cancer screening rates. Regular walkers, those engaged in moderate physical activity, and individuals with a previous cancer diagnosis were more likely to get screened. High-risk drinkers and smokers were less inclined towards screening. Dietary habits also influenced screening decisions. Notably, participants with healthier eating behaviors, indicated by factors such as regular breakfasts and fewer meals out, were more likely to undergo screening. Additionally, nutrient intake analysis revealed that those who had undergone screening consumed greater quantities of most nutrients, bar a few exceptions. For individuals aged 50-64, nutritional assessment indicators highlighted a higher mean adequacy ratio (MAR) and index of nutritional quality (INQ) value among those who participated in screening, suggesting better nutritional quality. This study elucidates the complex socio-ecological and nutritional landscape influencing cancer screening decisions. The results underscore the importance of a holistic approach, emphasizing lifestyle, dietary habits, and socio-economic considerations. It provides a roadmap for policymakers to craft more inclusive screening programs, ensuring equal access and promoting early detection.
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Affiliation(s)
- Seungpil Jeong
- Department of Medical Informatics, College of Medicine, Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Yean-Jung Choi
- Department of Food and Nutrition, Sahmyook University, Seoul 01795, Republic of Korea
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17
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Wethington SL, Rositch AF, Yu R, Bielman M, Topel K, Stone RL, Ferriss JS, Fader AN, Beavis AL. Integrating Social Needs Screening and Resource Referral Into Standard Ambulatory Oncology Care: A Quality Improvement Project. JCO Oncol Pract 2024; 20:566-571. [PMID: 38277618 DOI: 10.1200/op.23.00485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/20/2023] [Accepted: 11/22/2023] [Indexed: 01/28/2024] Open
Abstract
PURPOSE We previously implemented paper-based screening for health-related social resource needs (HRSN) in our gynecologic oncology clinic and found that 36% of patients who completed the screening reported HRSN. We identified two primary deficiencies with our process. First, only 52% of patients completed the screening. Second, 37% of patients with needs failed to indicate if they desired resource referral or not. Therefore, we conducted a quality improvement project to integrate screening and referral processes into the electronic medical record (EMR) and routine clinic workflow to achieve at least 90% screening compliance and 90% elicited referral preference. METHODS A multidisciplinary team consisting of physicians, a health outcomes researcher, a computer programmer, project assistants, and the staff of a partner community organization designed and implemented an intervention that screened for HRSN online via the EMR patient platform or in person during visits. The primary outcome was the percentage of eligible patients who completed the HRSN screening (ie, reach). Outcomes were reviewed weekly, and feedback was provided to stakeholders monthly. Iterative changes were incorporated into five successive Plan-Do-Study-Act (PDSA) cycles completed from January 2021 to March 2023. RESULTS Screening compliance increased from the baseline of 52% (paper-based) to 97% in PDSA 4. Completion via the online patient portal increased from 17% in prelaunch to 49% in PDSA 4. Of patients who reported needs, 100% had a documented referral preference. CONCLUSION Compared with paper-based screening, an EMR-integrated HRSN screening and referral system significantly improved reach to patients at a gynecologic oncology clinic. Implementation efforts to expand to other ambulatory clinic settings are in process.
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Affiliation(s)
- Stephanie L Wethington
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | | | - Ruoxi Yu
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Marie Bielman
- The Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Kristin Topel
- Hopkins Community Connection, Johns Hopkins University, Baltimore, MD
| | - Rebecca L Stone
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - James Stuart Ferriss
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Amanda N Fader
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Anna L Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
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18
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Byrne M, Sia TY, Fong C, Khurram A, Waters M, Kemel YM, Zhou Q, Ranganathan M, Long Roche K, Chi DS, Saban S, Wu M, Varice N, Hamilton JG, Carrot-Zhang J, Abu-Rustum NR, Iasonos A, Ellenson LH, Mandelker D, Weigelt B, Brown CL, Aghajanian C, Stadler Z, Liu YL. Mainstreaming in parallel with ovarian cancer tumor testing to improve genetic testing uptake. Gynecol Oncol 2024; 183:126-132. [PMID: 38493020 DOI: 10.1016/j.ygyno.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Although genetic testing (GT) is universally recommended for patients with epithelial ovarian cancer (EOC), rates are low (34%). In 1/2019, we implemented mainstreaming-GT in parallel with tumor testing via MSK-IMPACT within oncology clinics. We sought to determine GT rates pre/post-mainstreaming and patient characteristics associated with GT. METHODS Patients with newly diagnosed EOC seen at our institution from 7/1/2015-3/31/2022 were included. Clinical data were abstracted including social determinants of health (SDOH) variables, race/ethnicity, marital status, insurance, language, comorbidities, employment, and Yost index, a measure of socioeconomic status. GT rates were calculated overall and pre-/post-mainstreaming (1/2019). Logistic regression models were fit to identify variables associated with GT. RESULTS Of 1742 patients with EOC, 1591 (91%) underwent GT. Rates of GT increased from 87% to 95% after mainstreaming (p < 0.001). Among 151 patients not undergoing GT, major reasons were lack of provider recommendation (n = 76, 50%) and logistical issues (n = 38, 25%) with few declining (n = 14, 9%) or having medical complications preventing GT (n = 7, 4.6%). High-grade serous histology, advanced stage (III/IV), and having a spouse/partner were associated with increased GT uptake (p < 0.01). Among SDOH variables, there were no differences by insurance, Yost score, language, comorbidities, employment, or race/ethnicity. In multivariable models, likelihood of GT increased with mainstreaming, even after adjustment for histology, stage, and marital status (OR 3.77; 95% CI: 2.56-5.66). CONCLUSIONS Mainstreaming increased the likelihood of GT in patients with EOC. We found lower testing rates in patients without partners/spouses, non-high-grade serous histology, and early-stage disease, representing potential areas for future interventions.
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Affiliation(s)
- Maureen Byrne
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Tiffany Y Sia
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Christopher Fong
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Aliya Khurram
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Michele Waters
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Yelena M Kemel
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Megha Ranganathan
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Sally Saban
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Michelle Wu
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Nancy Varice
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Jada G Hamilton
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States of America; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Jian Carrot-Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Lora H Ellenson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Diana Mandelker
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Zsofia Stadler
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
| | - Ying L Liu
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
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Lorentsen MK, Sanoff HK. Social Determinants of Health and the Link to Colorectal Cancer Outcomes. Curr Treat Options Oncol 2024; 25:453-464. [PMID: 38498252 DOI: 10.1007/s11864-024-01191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
OPINION STATEMENT: Colorectal cancer (CRC) remains the second most deadly cancer in the United States, behind only lung cancer. Despite improvements in incidence due to screening and mortality in part due to better treatments, there are some groups that have not seen these promising changes. American Indian/Alaska Native and non-Hispanic Black individuals, certain geographic regions, and lower socioeconomic groups have all been shown to have worse CRC outcomes. A significant body of evidence has linked these disparities in outcomes to social determinants of health (SDH). SDH are defined by the WHO as "the non-medical factors that influence health outcomes." These factors include but are not limited to income, education, social support, neighborhood of residence, and access to healthcare. Individuals who are negatively impacted by SDH have been shown to have a higher incidence of CRC. These individuals are also less likely to receive adequate CRC screening, are less likely to receive appropriate treatment, and have increased CRC mortality. Interventions that target different SDH domains have been shown to lead to increased rates of CRC screening and receipt of appropriate treatment while simultaneously improving CRC mortality. The aim of this review is to highlight the connection between SDH and CRC outcomes while also exploring interventions that target SDH and thereby improve CRC outcomes.
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Affiliation(s)
- Michael K Lorentsen
- University of North Carolina at Chapel Hill, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA
- Division of Oncology, University of North Carolina at Chapel Hill, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA
| | - Hanna K Sanoff
- Division of Oncology, University of North Carolina at Chapel Hill, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA.
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Alaniz-Cantú EI, Goodwin K, Smith L, Acosta E, Chávez-Iñiguez A, Evans MJ, Gaitán M, Lei F, Yousefi-Nooraie R, Fiscella KA, Rivera MP, Cupertino AP, Cartujano-Barrera F. Understanding the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos: A qualitative study. Front Oncol 2024; 14:1365739. [PMID: 38571494 PMCID: PMC10987732 DOI: 10.3389/fonc.2024.1365739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Rates of lung cancer screening among Latinos remain low. The purpose of the study was to understand the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos. Methods Participants (N=20) were recruited using community-based recruitment strategies. Eligibility criteria included: 1) self-identified as Hispanic/Latino, 2) spoke English and/or Spanish, and 3) met the USA Preventive Services Task Force eligibility criteria for lung cancer screening. Interviews were conducted in Spanish and English, audio recorded, and transcribed verbatim. Using the health belief model, a qualitative theoretical analysis was used to analyze the interviews. Results Participants' mean age was 58.3 years old (SD=5.8), half of the participants were female, 55% had completed high school or lower educational level, and 55% reported speaking more Spanish than English. All participants were currently smoking. Fourteen participants (70%) were unaware of lung cancer screening, and eighteen (90%) did not know they were eligible for lung cancer screening. Regarding lung cancer screening, participants reported multiple perceived benefits (e.g., smoking cessation, early detection of lung cancer, increased survivorship) and barriers (e.g., fear of outcomes, cost, lung cancer screening not being recommended by their clinician). Lastly, multiple cues to actions for lung cancer screening were identified (e.g., family as a cue to action for getting screened). Conclusions Most Latinos who were eligible for lung cancer screening were unaware of it and, when informed, they reported multiple perceived benefits, barriers, and cues to action. These factors provide concrete operational strategies to address lung cancer screening among Latinos.
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Affiliation(s)
- Edgar I. Alaniz-Cantú
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Kalese Goodwin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - London Smith
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Eliany Acosta
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Arlette Chávez-Iñiguez
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Mary Jo Evans
- Imaging Population Health Programs, University of Rochester Medical Center, Rochester, NY, United States
| | - Marcela Gaitán
- National Alliance for Hispanic Health, Washington, DC, United States
| | - Fang Lei
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Kevin A. Fiscella
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - M. Patricia Rivera
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States
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Matejcic M, Teer JK, Hoehn HJ, Diaz DB, Shankar K, Gong J, Nguyen NT, Lorona N, Coppola D, Fulmer C, Saglam O, Jiang K, Cress D, Muñoz-Antonia T, Flores I, Gordian E, Oliveras Torres JA, Felder SI, Sanchez JA, Fleming J, Siegel EM, Freedman JA, Dutil J, Stern MC, Fridley BL, Figueiredo JC, Schmit SL. Spectrum of somatic mutational features of colorectal tumors in ancestrally diverse populations. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.11.24303880. [PMID: 38558992 PMCID: PMC10980113 DOI: 10.1101/2024.03.11.24303880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Ancestrally diverse and admixed populations, including the Hispanic/Latino/a/x/e community, are underrepresented in cancer genetic and genomic studies. Leveraging the Latino Colorectal Cancer Consortium, we analyzed whole exome sequencing data on tumor/normal pairs from 718 individuals with colorectal cancer (128 Latino, 469 non-Latino) to map somatic mutational features by ethnicity and genetic ancestry. Global proportions of African, East Asian, European, and Native American ancestries were estimated using ADMIXTURE. Associations between global genetic ancestry and somatic mutational features across genes were examined using logistic regression. TP53 , APC , and KRAS were the most recurrently mutated genes. Compared to non-Latino individuals, tumors from Latino individuals had fewer KRAS (OR=0.64, 95%CI=0.41-0.97, p=0.037) and PIK3CA mutations (OR=0.55, 95%CI=0.31-0.98, p=0.043). Genetic ancestry was associated with presence of somatic mutations in 39 genes (FDR-adjusted LRT p<0.05). Among these genes, a 10% increase in African ancestry was associated with significantly higher odds of mutation in KNCN (OR=1.34, 95%CI=1.09-1.66, p=5.74×10 -3 ) and TMEM184B (OR=1.53, 95%CI=1.10-2.12, p=0.011). Among RMGs, we found evidence of association between genetic ancestry and mutation status in CDC27 (LRT p=0.0084) and between SMAD2 mutation status and AFR ancestry (OR=1.14, 95%CI=1.00-1.30, p=0.046). Ancestry was not associated with tumor mutational burden. Individuals with above-average Native American ancestry had a lower frequency of microsatellite instable (MSI-H) vs microsatellite stable tumors (OR=0.45, 95%CI=0.21-0.99, p=0.048). Our findings provide new knowledge about the relationship between ancestral haplotypes and somatic mutational profiles that may be useful in developing precision medicine approaches and provide additional insight into genomic contributions to cancer disparities. Significance Our data in ancestrally diverse populations adds essential information to characterize mutational features in the colorectal cancer genome. These results will help enhance equity in the development of precision medicine strategies.
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Anderson EC, DiPalazzo J, Lucas FL, Hall MJ, Antov A, Helbig P, Bourne J, Graham L, Gaitor L, Lu-Emerson C, Bradford LS, Inhorn R, Sinclair SJ, Brooks PL, Thomas CA, Rasmussen K, Han PKJ, Liu ET, Rueter J. Genome-matched treatments and patient outcomes in the Maine Cancer Genomics Initiative (MCGI). NPJ Precis Oncol 2024; 8:67. [PMID: 38461318 PMCID: PMC10924947 DOI: 10.1038/s41698-024-00547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024] Open
Abstract
Genomic tumor testing (GTT) is an emerging technology aimed at identifying variants in tumors that can be targeted with genomically matched drugs. Due to limited resources, rural patients receiving care in community oncology settings may be less likely to benefit from GTT. We analyzed GTT results and observational clinical outcomes data from patients enrolled in the Maine Cancer Genomics Initiative (MCGI), which provided access to GTTs; clinician educational resources; and genomic tumor boards in community practices in a predominantly rural state. 1603 adult cancer patients completed enrollment; 1258 had at least one potentially actionable variant identified. 206 (16.4%) patients received a total of 240 genome matched treatments, of those treatments, 64% were FDA-approved in the tumor type, 27% FDA-approved in a different tumor type and 9% were given on a clinical trial. Using Inverse Probability of Treatment Weighting to adjust for baseline characteristics, a Cox proportional hazards model demonstrated that patients who received genome matched treatment were 31% less likely to die within 1 year compared to those who did not receive genome matched treatment (HR: 0.69; 95% CI: 0.52-0.90; p-value: 0.006). Overall, GTT through this initiative resulted in levels of genome matched treatment that were similar to other initiatives, however, clinical trials represented a smaller share of treatments than previously reported, and "off-label" treatments represented a greater share. Although this was an observational study, we found evidence for a potential 1-year survival benefit for patients who received genome matched treatments. These findings suggest that when disseminated and implemented with a supportive infrastructure, GTT may benefit cancer patients in rural community oncology settings, with further work remaining on providing genome-matched clinical trials.
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Affiliation(s)
- Eric C Anderson
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - John DiPalazzo
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | - F Lee Lucas
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | | | | | | | | | | | | | | | - Leslie S Bradford
- Maine Medical Partners Women's Health, Gynecologic Oncology, Scarborough, ME, USA
| | - Roger Inhorn
- PenBay Medical Center Oncology, Rockport, ME, USA
| | | | | | | | | | - Paul K J Han
- Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME, USA
- National Cancer Institute, Bethesda, MD, USA
| | - Edison T Liu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
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Dako F, Holden N, Narayan A, Guerra C. Understanding Health-Related Social Risks. J Am Coll Radiol 2024:S1546-1440(24)00280-1. [PMID: 38461918 DOI: 10.1016/j.jacr.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/21/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
Because of the established contribution of social factors to health outcomes, approaches that address upstream determinants of health have increasingly been recognized as cost-effective means to improve population health. Understanding and usage of precise terminology is important to facilitate collaboration across disciplines. Social determinants of health affect everyone, not just the socially and economically disadvantaged, whereas health-related social risks (HRSR) are specific adverse conditions at the individual or family level that are associated with poor health and related to the immediate challenges individuals face. Health-related social needs account for patient preference in addressing identified social risks. The use of validated screening tools is important to capture risk factors in a standardized fashion to support research and quality improvement. There is a paucity of studies that address HRSR in the context of radiology. This review provides an understanding of HRSR and outlines various ways in which radiologists can work to mitigate them.
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Affiliation(s)
- Farouk Dako
- Director, Center for Global and Population Health Research in Radiology, Senior Fellow, Leonard Davis Institute of Health Economics, and Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Natasha Holden
- College of Osteopathic Medicine of the Pacific Western University of Health Sciences, Pomona, California
| | - Anand Narayan
- Vice Chair, Health Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carmen Guerra
- Vice Chair of Diversity and Inclusion, Department of Medicine, and Associate Director of Diversity and Inclusion, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Peppercorn J. What's Going On?: A Call for Rededication to Addressing Disparities in Oncology Practice. JCO Oncol Pract 2024; 20:305-307. [PMID: 38394606 DOI: 10.1200/op.24.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Springer R, Erroba J, O'Malley JP, Huguet N. Differences in up-to-date colorectal and cervical cancer screening rates by ethnicity and preferred language: An analysis across patient-, clinic-, and area-level data sources. SSM Popul Health 2024; 25:101612. [PMID: 38322786 PMCID: PMC10844668 DOI: 10.1016/j.ssmph.2024.101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/08/2024] Open
Abstract
Research objective There is interest in using clinic- and area-level data to inform cancer control, but it is unclear what value these sources may add in combination with patient-level data sources. This study aimed to investigate associations of up-to-date colorectal and cervical cancer screenings at community health centers (CHCs) with ethnicity and language variables at patient-, clinic-, and area-levels, while exploring whether patient-level associations differed based on clinic-level patient language and ethnicity distributions. Study design This was a cross-sectional study using data from multiple sources, including electronic health records, clinic patient panel data, and area-level demographic data. The study sample included English-preferring Hispanic, Spanish-preferring Hispanic, English-preferring non-Hispanic, and non-English-preferring non-Hispanic patients eligible for either colorectal cancer (N = 98,985) or cervical cancer (N = 129,611) screenings in 2019 from 130 CHCs in the OCHIN network in CA, OR, and WA. Population studied The study population consisted of adults aged 45+ eligible for colorectal cancer screening and adults with a cervix aged 25-65 eligible for cervical cancer screening. Principal findings Spanish-preferring Hispanic patients were significantly more likely to be up-to-date with colorectal and cervical cancer screenings than other groups. Patients seen at clinics with higher concentrations of Spanish-preferring Hispanics were significantly more likely to be up-to-date, as were individuals residing in areas with higher percentages of Spanish-speaking residents. Differential associations between patient ethnicity and language and up-to-date colorectal cancer screenings were greater among patients seen at clinics with higher concentrations of Spanish-preferring Hispanics. Conclusions The findings highlight that Spanish-speaking Hispanics seen in CHCs have higher rates of up-to-date cervical and colorectal cancer screenings than other groups and that this relationship is stronger at clinics with higher percentages of Spanish-preferring Hispanic patients. Our findings suggest area-level variables are not good substitutions for patient-level data, but variables at the clinic patient panel-level are more informative.
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Affiliation(s)
- Rachel Springer
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy Erroba
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
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McMahon M, McCallion P, McCarron M. An invisible population: Late-stage cancer diagnosis for people with intellectual or developmental disability. Cancer 2024; 130:668-670. [PMID: 38014927 DOI: 10.1002/cncr.35132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Mahar et al. found that people with intellectual or developmental disabilities are more likely to be diagnosed with metastatic breast (female) and colorectal cancer in comparison to the general population. This editorial discusses the urgent need to develop effective strategies aimed at reducing this inequity for people with intellectual or developmental disabilities.
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Affiliation(s)
- Martin McMahon
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
- Trinity Centre for Ageing and Intellectual Disability (TCAID), School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
| | - Phillip McCallion
- Trinity Centre for Ageing and Intellectual Disability (TCAID), School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
- School of Social Work (College of Public Health), Temple University, Philadelphia, Pennsylvania, USA
| | - Mary McCarron
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
- Trinity Centre for Ageing and Intellectual Disability (TCAID), School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
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Parma DL, Finley EP, Fernandez R, Gelfond JAL, Ramirez AG. Facilitators of and barriers to gastric cancer and precursor diagnosis among South Texas residents: Social determinants of health. Cancer Med 2024; 13:e7002. [PMID: 38506232 PMCID: PMC10952019 DOI: 10.1002/cam4.7002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Latinos/Hispanics are at higher risk for developing gastric cancer (GC) compared with non-Hispanic whites, and social determinants of health (SDoH) are thought to contribute. AIMS/MATERIALS AND METHODS This study addressed SDoH and their interactions contributing to disparities in the testing and treatment of Helicobacter pylori (HP) infection and diagnosis of GC and its known precursors, among Latinos/Hispanics relative to non-Latinos at two affiliated but independent health systems in San Antonio, Texas, using a mixed methods approach. RESULTS Secondary data abstraction and analysis showed that GCs represented 2.6% (n = 600) of our population. Men and older individuals were at higher GC risk. Individuals with military insurance were 2.7 times as likely to be diagnosed as private insurance. Latinos/Hispanics had significantly (24%) higher GC risk than Whites. Poverty and lack of insurance contributed to GC risk among the minorities classified as other (Asians, Native Americans, Multiracial; all p < 0.01). All SDoH were associated with H. pylori infection (p < 0.001). Qualitative analysis of patient and provider interviews showed providers reporting insurance as a major care barrier; patients reported appointment delays, and lack of clinic staff. Providers universally agreed treatment of H. pylori was necessary, but disagreed on its prevalence. Patients did not report discussing H. pylori or its cancer risk with providers. DISCUSSION/CONCLUSION These data indicate the importance of considering SDoH in diagnosis and treatment of GC and its precursors, and educating providers and patients on H. pylori risks for GC.
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Affiliation(s)
- Dorothy Long Parma
- Department of Population Health Sciences, Long School of MedicineThe University of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Erin P. Finley
- Department of Medicine and Psychiatry and Behavioral Sciences, Long School of MedicineThe University of Texas Health Science Center at San AntonioSan AntonioTexasUSA
- Center for Healthcare Innovation, Implementation and PolicyVirginia Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Roman Fernandez
- Department of Population Health Sciences, Long School of MedicineThe University of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Jonathan A. L. Gelfond
- Department of Population Health Sciences, Long School of MedicineThe University of Texas Health Science Center at San AntonioSan AntonioTexasUSA
| | - Amelie G. Ramirez
- Department of Population Health Sciences, Long School of MedicineThe University of Texas Health Science Center at San AntonioSan AntonioTexasUSA
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29
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Somayaji D, Mohedat H, Li CS. Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care. Cancer Nurs 2024:00002820-990000000-00215. [PMID: 38416076 DOI: 10.1097/ncc.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods. OBJECTIVE This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment. METHODS A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person. RESULTS Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment. CONCLUSIONS The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care. IMPLICATIONS FOR PRACTICE Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.
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Affiliation(s)
- Darryl Somayaji
- Author Affiliation: School of Nursing, University at Buffalo (Dr Somayaji and Mrs Mohedat), New York; and Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center (Dr Li), Rochester, New York
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30
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Hippalgaonkar N, Nguyen RHT, Cohn EB, Horowitz J, Waite AW, Mersha T, Sandoval C, Khan S, Salum K, Thomas P, Murphy AM, Brent B, Coleman L, Khosla P, Hoskins KF, Henderson V, Carnahan LR. Are We the Problem? A Call to Action for Addressing Institutional Challenges to Engaging Community Partners in Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:236. [PMID: 38397725 PMCID: PMC10888328 DOI: 10.3390/ijerph21020236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Community-engaged research (CEnR) is a potent tool for addressing health inequities and fostering equitable relationships among communities, researchers, and institutions. CEnR involves collaboration throughout the research process, demonstrating improvements in study recruitment and retention, intervention efficacy, program sustainability, capacity building among partners, and enhanced cultural relevance. Despite the increasing demand for CEnR, institutional policies, particularly human participation protection training (HPP), lag behind, creating institutional barriers to community partnerships. Here, we highlight challenges encountered in our ongoing study, Fostering Opportunities in Research through Messaging and Education (FOR ME), focused on promoting shared decision-making around clinical trial participation among Black women diagnosed with breast cancer. Grounded in CEnR methods, FOR ME has a partnership with a community-based organization (CBO) that addresses the needs of Black women with breast cancer. Our CBO partner attempted to obtain HPP training, which was administratively burdensome and time-consuming. As CEnR becomes more prevalent, academic and research institutions, along with researchers, are faced with a call to action to become more responsive to community partner needs. Accordingly, we present a guide to HPP training for community partners, addressing institutional barriers to community partner participation in research. This guide outlines multiple HPP training pathways for community partners, aiming to minimize institutional barriers and enhance their engagement in research with academic partners.
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Affiliation(s)
- Neha Hippalgaonkar
- Division of Hematology/Oncology, University of Illinois Chicago, Chicago, IL 60612, USA; (R.H.-T.N.); (K.F.H.)
| | - Ryan Huu-Tuan Nguyen
- Division of Hematology/Oncology, University of Illinois Chicago, Chicago, IL 60612, USA; (R.H.-T.N.); (K.F.H.)
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
| | - Eliza Brumer Cohn
- Fred Hutchinson Cancer Center, Seattle, WA 98126, USA; (E.B.C.); (K.S.); (V.H.)
| | - Joseph Horowitz
- Department of Medicine and Pediatrics, University of Illinois College of Medicine, Chicago, IL 60612, USA;
| | - Ana Williams Waite
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
| | - Tigist Mersha
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (C.S.); (A.M.M.)
| | - Christen Sandoval
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (C.S.); (A.M.M.)
| | - Sarah Khan
- Sinai Chicago, Chicago, IL 60612, USA; (S.K.); (P.K.)
| | - Kauthar Salum
- Fred Hutchinson Cancer Center, Seattle, WA 98126, USA; (E.B.C.); (K.S.); (V.H.)
| | | | - Anne Marie Murphy
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (C.S.); (A.M.M.)
| | - Beulah Brent
- Sisters Working It Out, Chicago, IL 60612, USA; (B.B.); (L.C.)
| | - Lolita Coleman
- Sisters Working It Out, Chicago, IL 60612, USA; (B.B.); (L.C.)
| | | | - Kent F. Hoskins
- Division of Hematology/Oncology, University of Illinois Chicago, Chicago, IL 60612, USA; (R.H.-T.N.); (K.F.H.)
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
| | - Vida Henderson
- Fred Hutchinson Cancer Center, Seattle, WA 98126, USA; (E.B.C.); (K.S.); (V.H.)
| | - Leslie R. Carnahan
- University of Illinois Cancer Center, Chicago, IL 60612, USA; (A.W.W.); (T.M.); (L.R.C.)
- School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA; (C.S.); (A.M.M.)
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Molina Y, Tsai E, Enqubahry Y, Lee E, Siddiqi F, Gottesman A, Boylan E, Paz K, Wright ME, Abrol E, Lofton S, Kim SJ, Patel A. Equity in Cancer and Chronic Disease Prevention through a Multi-Pronged Network Intervention: Works-in-Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:213. [PMID: 38397702 PMCID: PMC10888495 DOI: 10.3390/ijerph21020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
The increasing rates of cancer incidence are disproportionately borne by populations that are ineligible for screening and historically marginalized populations. To address this need, our community-centered model seeks to catalyze the widespread diffusion of evidence-based information and resources (e.g., community-based organizations, federally qualified health centers) to reduce the risks of cancer, chronic disease, and other conditions. In this study, we tested whether improving personal health literacy (i.e., confidence in seeking information) and enabling successful information transfer (i.e., intention to share the specific information learned through the program) among community residents could contribute to greater diffusion intention (i.e., number of network members with whom residents plan to share information and resources). The current study used post-intervention surveys, which were administered to Chicago residents who were 18 years or older and had participated in the program. Among the 1499 diverse Chicago residents, improved personal health literacy was associated with greater diffusion intention (ORs = 2.00-2.68, 95% CI [1.27-4.39], p ≤ 0.003). Successful information transfer was associated with greater diffusion, especially for cancer and other chronic disease risk reductions (ORs = 3.43-3.73, 95% CI [1.95-6.68], p < 0.001). The findings highlight the potential gains for health equity through sustainable, scalable, multi-sectoral partnerships.
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Affiliation(s)
- Yamilé Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Edward Tsai
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Yalemzewod Enqubahry
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Eunhye Lee
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Faria Siddiqi
- Division of Community Health Sciences, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (Y.E.); (E.L.); (F.S.)
| | - Anna Gottesman
- School of Public Health, George Washington Milkin Institute, Washington, DC 20037, USA;
| | - Emma Boylan
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
| | - Kate Paz
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
| | - Margaret E. Wright
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Ekas Abrol
- University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA; (E.T.); (M.E.W.); (E.A.)
| | - Saria Lofton
- Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Sage J. Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Ajanta Patel
- Chicago Department of Public Health, Chicago, IL 60612, USA; (E.B.); (K.P.); (A.P.)
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Jhumkhawala V, Lobaina D, Okwaraji G, Zerrouki Y, Burgoa S, Marciniak A, Densley S, Rao M, Diaz D, Knecht M, Sacca L. Social determinants of health and health inequities in breast cancer screening: a scoping review. Front Public Health 2024; 12:1354717. [PMID: 38375339 PMCID: PMC10875738 DOI: 10.3389/fpubh.2024.1354717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction This scoping review aims to highlight key social determinants of health associated with breast cancer screening behavior in United States women aged ≥40 years old, identify public and private databases with SDOH data at city, state, and national levels, and share lessons learned from United States based observational studies in addressing SDOH in underserved women influencing breast cancer screening behaviors. Methods The Arksey and O'Malley York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. Results The 72 included studies were published between 2013 and 2023. Among the various SDOH identified, those related to socioeconomic status (n = 96) exhibited the highest frequency. The Health Care Access and Quality category was reported in the highest number of studies (n = 44; 61%), showing its statistical significance in relation to access to mammography. Insurance status was the most reported sub-categorical factor of Health Care Access and Quality. Discussion Results may inform future evidence-based interventions aiming to address the underlying factors contributing to low screening rates for breast cancer in the United States.
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Affiliation(s)
- Vama Jhumkhawala
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Diana Lobaina
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Goodness Okwaraji
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Yasmine Zerrouki
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Sara Burgoa
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Adeife Marciniak
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Sebastian Densley
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Meera Rao
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Daniella Diaz
- Charles E. Schmidt College of Science, Boca Raton, FL, United States
| | - Michelle Knecht
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Lea Sacca
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
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Li C, Mowery DL, Ma X, Yang R, Vurgun U, Hwang S, Donnelly HK, Bandhey H, Akhtar Z, Senathirajah Y, Sadhu EM, Getzen E, Freda PJ, Long Q, Becich MJ. Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.04.24302242. [PMID: 38370703 PMCID: PMC10871446 DOI: 10.1101/2024.02.04.24302242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion Despite progress identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfill the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
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Affiliation(s)
- Chenyu Li
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Danielle L. Mowery
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Xiaomeng Ma
- University of Toronto, Institute of Health Policy Management and Evaluations
| | - Rui Yang
- Duke-NUS Medical School, Centre for Quantitative Medicine
| | - Ugurcan Vurgun
- University of Pennsylvania, Institute for Biomedical Informatics
| | - Sy Hwang
- University of Pennsylvania, Institute for Biomedical Informatics
| | | | - Harsh Bandhey
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Zohaib Akhtar
- Northwestern University, Kellogg School of Management
| | - Yalini Senathirajah
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Eugene Mathew Sadhu
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Emily Getzen
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Qi Long
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Michael J. Becich
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
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Smith SM, Teer A, Tolamatl Ariceaga E, Billman E, Benedict C, Goyal A, Pang EM, Pecos-Duarte C, Lewinsohn R, Smith M, Boynton H, Montes S, Rivera E, Ramirez D, Schapira L. A qualitative study of childhood cancer families' post-treatment needs and the impact of a community-based organization in a rural, socioeconomically disadvantaged, majority Hispanic/Latino region. Pediatr Blood Cancer 2024; 71:e30798. [PMID: 38053230 DOI: 10.1002/pbc.30798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Individual- and population-level socioeconomic disadvantages contribute to unequal outcomes among childhood cancer survivors. Reducing health disparities requires understanding experiences of survivors from historically marginalized communities, including those with non-English language preference. PROCEDURE We partnered with a community-based organization (CBO) serving families of children with cancer in a rural region in California with low socioeconomic status and majority Hispanic/Latino (H/L) residents. We interviewed English- and Spanish-speaking adolescent/young adult (AYA) childhood cancer survivors (≥15 years old, ≥5 years from diagnosis), parents, and CBO staff to evaluate post-treatment needs and impact of CBO support. Data were analyzed qualitatively using applied thematic analysis. Themes were refined through team discussions with our community partners. RESULTS Twelve AYAs (11 H/L, 11 bilingual), 11 parents (eight H/L, seven non-English preferred), and seven CBO staff (five H/L, five bilingual) participated. AYAs (five female, seven male) were of median (min-max) age 20 (16-32) and 9 (5-19) years post diagnosis; parents (nine female, two male) were age 48 (40-60) and 14 (6-23) years post child's diagnosis. Themes included challenges navigating healthcare, communication barriers among the parent-AYA-clinician triad, and lasting effects of childhood cancer on family dynamics and mental health. Subthemes illustrated that language and rurality may contribute to health disparities. CBO support impacted families by serving as a safety-net, fostering community, and facilitating H/L families' communication. CONCLUSIONS Childhood cancer has long-lasting effects on families, and those with non-English language preference face additional burdens. Community-based support buffers some of the negative effects of childhood cancer and may reduce disparities.
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Affiliation(s)
- Stephanie M Smith
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anmol Teer
- UC Berkeley School of Public Health, Berkeley, California, USA
| | | | - Elle Billman
- Stanford University School of Medicine, Stanford, California, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anju Goyal
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Emily M Pang
- Stanford University School of Medicine, Stanford, California, USA
| | - Caroline Pecos-Duarte
- Stanford University School of Medicine, Stanford, California, USA
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca Lewinsohn
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Smith
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Heidi Boynton
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Sandy Montes
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Esmeralda Rivera
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Daniela Ramirez
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford, California, USA
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, California, USA
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Das RK, Galdyn IA, Perdikis G, Drolet BC, Terhune KP. National patterns in the use of International Statistical Classification of Diseases and Health Related Problems, tenth revision Z codes in ambulatory surgery from 2016 to 2019. Am J Surg 2024; 228:54-61. [PMID: 37407393 DOI: 10.1016/j.amjsurg.2023.06.030] [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: 04/29/2023] [Revised: 05/23/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND In the tenth revision of the International Statistical Classification of Disease and Health Related Problems (ICD-10), Z codes were added to improve documentation and understanding of health-related social needs. We estimated national Z code use in the ambulatory surgery setting from 2016 to 2019. METHODS Using the Nationwide Ambulatory Surgery Sample (NASS), we identified encounters for ambulatory surgery with an ICD-10 code between Z55.0 and Z65.9. Data were stratified by Z code domains from the Centers for Medicare and Medicaid Services (CMS). RESULTS This analysis of 41,827 ambulatory surgery encounters with documented Z codes found that the most documented determinants of health related to multiparity or unwanted pregnancy, homelessness, and incarceration. There was a 16.1% increase in the use of Z codes from 2016 to 2019. CONCLUSION Rates of Z code use in the ambulatory surgery setting are increasing with current documentation serving as a specific but not sensitive measure of socioeconomic need.
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Affiliation(s)
- Rishub K Das
- Vanderbilt University School of Medicine, Nashville, TN, United States.
| | - Izabela A Galdyn
- Vanderbilt University School of Medicine, Department of Plastic Surgery, Nashville, TN, United States
| | - Galen Perdikis
- Vanderbilt University School of Medicine, Department of Plastic Surgery, Nashville, TN, United States
| | - Brian C Drolet
- Vanderbilt University School of Medicine, Department of Plastic Surgery, Nashville, TN, United States
| | - Kyla P Terhune
- Vanderbilt University School of Medicine, Department of Surgery, Nashville, TN, United States
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Loehrer AP, Green SR, Winkfield KM. Inequity in Cancer and Cancer Care Delivery in the United States. Hematol Oncol Clin North Am 2024; 38:1-12. [PMID: 37673697 PMCID: PMC10840640 DOI: 10.1016/j.hoc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Inequity exists along the continuum of cancer and cancer care delivery in the United States. Marginalized populations have later stage cancer at diagnosis, decreased likelihood of receiving cancer-directed care, and worse outcomes from treatment. These inequities are driven by historical, structural, systemic, interpersonal, and internalized factors that influence cancer across the pathologic and clinical continuum. To ensure equity in cancer care, interventions are needed at the level of policy, care delivery, interpersonal communication, diversity within the clinical workforce, and clinical trial accessibility and design.
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Affiliation(s)
- Andrew P Loehrer
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA; Dartmouth Cancer Center, Lebanon, NH, USA.
| | - Sybil R Green
- American Society of Clinical Oncology, 2318 Mill Road, Suite 800, Alexandria, VA 22314, USA
| | - Karen M Winkfield
- Vanderbilt University Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN 37232, USA; Meharry-Vanderbilt Alliance, 1005 Dr DB Todd Jr Boulevard, Nashville, TN 37208, USA
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Black AK, Kahn AE, Lamy C, Warman R, Barengo NC. The association between race and age of diagnosis of retinoblastoma in United States children. J AAPOS 2024; 28:103810. [PMID: 38237725 DOI: 10.1016/j.jaapos.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE To explore the associations between race and retinoblastoma diagnosis in United States children. METHODS In this analytical nonconcurrent cohort study, we used 1988-2018 data from the Surveillance, Epidemiology, and End-Results (SEER) database. Children ages 0-17 with retinoblastoma were included (n = 758); those with missing data were excluded (n = 11; final cohort: n = 747). The exposure variable was race (White, Black, Asian/Pacific Islanders, American Indian/Alaska Native), and the outcome variable was diagnosis of retinoblastoma before versus after 2 years of age. Covariates included sex, rural-urban continuum, ethnicity, decade of diagnosis, and laterality of disease. Unadjusted and adjusted logistic regression analyses were performed to calculate odds ratios and 95% confidence intervals. RESULTS No statistically significant association was found between racial/ethnic groups (OR = 0.61-0.99; P = 0.92) and age at diagnosis (OR = 0.86; P = 0.66). Females were more likely to be diagnosed earlier than males (OR = 0.62; 95% CI, 0.44-0.88; P = 0.042). No association was found between urban versus rural subjects (OR = 1.02; 95% CI, 0.60-1.75) or between decades (OR = 0.81; 95% CI, 0.54-1.22 and OR 0.96; 95% CI, 0.62-1.47). CONCLUSIONS We found no statistically significant difference between racial/ethnic groups for diagnosis of children with retinoblastoma after 2 years of age. Future studies could explore why females are more likely than males to be diagnosed before 2 years of age.
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Affiliation(s)
- Alexander K Black
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida.
| | - Amanda E Kahn
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Chrisnel Lamy
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Roberto Warman
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Noël C Barengo
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
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Moazzam Z, Woldesenbet S, Munir MM, Lima HA, Alaimo L, Endo Y, Cloyd J, Dillhoff M, Ejaz A, Pawlik TM. Mediators of racial disparities in postoperative outcomes among patients undergoing complex surgery. Am J Surg 2024; 228:165-172. [PMID: 37743217 DOI: 10.1016/j.amjsurg.2023.09.014] [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: 06/17/2023] [Revised: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND This study sought to quantify the direct and indirect effects of race on postoperative outcomes after complex surgery. METHODS Medicare patients who underwent abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting (CABG), lung resection or colectomy were identified (2014-2018). Generalized structural equation modelling was utilized to quantify the direct and indirect effects of race on Textbook outcome (TO). RESULTS Among 930,033 patients, 46.8% of patients achieved a TO, with Black patients less likely to achieve a TO (referent: White; Black: OR 0.72, 95% CI 0.70-0.73). Notably, 32.3% of the disparities in TO were attributable to race itself, while 67.7% was explained by other factors. Specifically, residential segregation accounted for 39.4% of the lower TO rates among Black patients, while 21.0% was attributable to a high comorbidity burden. CONCLUSIONS These data highlight the need to target structural racism as a policy priority to promote a more equitable healthcare system.
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Affiliation(s)
- Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Nogueira L, Florez N. The Impact of Climate Change on Global Oncology. Hematol Oncol Clin North Am 2024; 38:105-121. [PMID: 37580192 DOI: 10.1016/j.hoc.2023.07.004] [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: 08/16/2023]
Abstract
Climate change is the greatest threat to human health of our time, with significant implications for global cancer control efforts. The changing frequency and behavior of climate-driven extreme weather events results in more frequent and increasingly unanticipated disruptions in access to cancer care. Given the significant threat that climate change poses to cancer control efforts, oncology professionals should champion initiatives that help protect the health and safety of patients with cancer, such as enhancing emergency preparedness and response efforts and reducing emissions from our own professional activities, which has health cobenefits for the entire population.
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Affiliation(s)
- Leticia Nogueira
- Surveillance and Health Equity Sciences, American Cancer Society, Palm Harbor, FL, USA.
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Decker HC, Graham LA, Titan A, Hawn MT, Kanzaria HK, Wick E, Kushel MB. Housing Status Changes Are Associated With Cancer Outcomes Among US Veterans. Health Aff (Millwood) 2024; 43:234-241. [PMID: 38315919 DOI: 10.1377/hlthaff.2023.01003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Cancer is a leading cause of death in older unhoused adults. We assessed whether being unhoused, gaining housing, or losing housing in the year after cancer diagnosis is associated with poorer survival compared with being continuously housed. We examined all-cause survival in more than 100,000 veterans diagnosed with lung, colorectal, and breast cancer during the period 2011-20. Five percent were unhoused at the time of diagnosis, of whom 21 percent gained housing over the next year; 1 percent of veterans housed at the time of diagnosis lost housing. Continuously unhoused veterans and veterans who lost their housing had poorer survival after lung and colorectal cancer diagnosis compared with those who were continuously housed. There was no survival difference between veterans who gained housing after diagnosis and veterans who were continuously housed. These findings support policies to prevent and end homelessness in people after cancer diagnosis, to improve health outcomes.
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Affiliation(s)
- Hannah C Decker
- Hannah C. Decker , University of California San Francisco, San Francisco, California
| | - Laura A Graham
- Laura A. Graham, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Ashley Titan
- Ashley Titan, Stanford University, Stanford, California
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Fan Q, Hussaini SMQ, Barrow LCJ, Feliciano JL, Pollack CE, Yabroff KR, Nogueira L. Association of area-level mortgage denial and guideline-concordant non-small-cell lung cancer care and outcomes in the United States. Cancer Med 2024; 13:e6921. [PMID: 38205942 PMCID: PMC10911071 DOI: 10.1002/cam4.6921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/08/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Racial and socioeconomic disparities in receipt of care for non-small-cell lung cancer (NSCLC) are well described. However, no previous studies have evaluated the association between mortgage denial rates and receipt of timely and guideline-concordant care for NSCLC and patient outcomes. METHODS We identified individuals ≥18 years diagnosed with NSCLC between 2014 and 2019 from the National Cancer Database. Using the Home Mortgage Disclosure Act database, we calculated the proportion of denied home loans to total loans at the zip-code level and categorized them into quintiles. Our outcomes included receipt of guideline-concordant care based on clinical and pathologic stage at diagnosis and the National Comprehensive Cancer Network guidelines, time from surgery to chemotherapy initiation, and overall survival. RESULTS Of the 629,288 individuals diagnosed with NSCLC (median age 69; IQR 61-76 years, 49.1% female), 47.8% did not receive guideline-concordant care. Residing in areas with higher mortgage denial rates and lower income was associated with worse guideline-concordant care overall (aRR = 1.28; 95% CI = 1.25-1.32) and for each cancer treatment modality, worse receipt of timely chemotherapy (aHR = 1.14; 95% CI = 1.11-1.17) and worse overall survival (aHR = 1.21; 95% CI = 1.19-1.22), compared with residing in areas with the lowest mortgage denial rate and highest income. CONCLUSIONS Area-level mortgage denial rate was associated with worse receipt of timely and guideline-concordant NSCLC care and survival. This highlights the critical need to understand and address systemic practices, such as mortgage denial, that limit access to resources and are associated with worse access to quality cancer care and outcomes.
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Affiliation(s)
- Qinjin Fan
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - S M Qasim Hussaini
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Lauren C J Barrow
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Josephine L Feliciano
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Craig E Pollack
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Leticia Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Fay M, Hu M, Hajizadeh M. Socioeconomic inequalities in cervical cancer mortality in Canada, 1990 and 2019: a trend analysis. Public Health 2024; 227:210-218. [PMID: 38241902 DOI: 10.1016/j.puhe.2023.12.014] [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: 04/28/2023] [Revised: 07/19/2023] [Accepted: 12/08/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE It is increasingly recognized that those of lower socioeconomic status (SES) are disproportionately affected by cancer mortality. The association between cervical cancer mortality and SES have been reported; however, it remains poorly understood in the Canadian population. Thus, this study investigates trends in income and education inequalities in cervical cancer mortality in Canada over the last three decades. STUDY DESIGN Trend analysis. METHODS A dataset constructed at the census division level (n = 280), comprising the Canadian Vital Statistics Death Database, the Canadian Census of Population, and the National Household Survey was used to measure cervical cancer mortality in Canada. Income and education inequalities in cervical cancer mortality were measured using age-standardized Concentration index (C). RESULTS Crude cervical cancer mortality rates decreased significantly during the study period. Age-standardized C values were negative for the majority of years for income and education inequalities, reaching significance in some years. Trend analyses indicated an increasing concentration of cervical cancer mortality amongst those with lower education levels. CONCLUSION Despite recent decreases in cervical cancer mortality rates, socioeconomic inequalities in cervical cancer mortality in Canada are persistent. Notably, those of lower income and education levels are disproportionately affected, underscoring an opportunity to improve clinical outcomes by addressing these inequalities.
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Affiliation(s)
- M Fay
- Faculty of Medicine, Dalhousie University, Canada
| | - M Hu
- Department of Economics, Philosophy, and Political Science, University of British Columbia, Okanagan Campus, Canada
| | - M Hajizadeh
- School of Health Administration, Dalhousie University, Canada.
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Nogueira LM, Yabroff KR. Climate change and cancer: the Environmental Justice perspective. J Natl Cancer Inst 2024; 116:15-25. [PMID: 37813679 DOI: 10.1093/jnci/djad185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 10/11/2023] Open
Abstract
Despite advances in cancer control-prevention, screening, diagnosis, treatment, and survivorship-racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population.
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Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Melkonian SC, Jim MA, Reza A, Peipins LA, Haverkamp D, Said N, Sharpe JD. Incidence of Stomach, Liver, and Colorectal Cancers by Geography and Social Vulnerability Among American Indian and Alaska Native Populations, 2010-2019. Am J Epidemiol 2024; 193:58-74. [PMID: 37823258 PMCID: PMC10990004 DOI: 10.1093/aje/kwad194] [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: 02/08/2023] [Revised: 07/12/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
Social determinants of health and associated systems, policies, and practices are important drivers of health disparities. American Indian and Alaska Native (AI/AN) populations in the United States have elevated incidence rates of stomach, liver, and colorectal cancers compared with other racial/ethnic groups. In this study, we examined incidence rates of 3 types of gastrointestinal cancer among non-Hispanic AI/AN (NH-AI/AN) and non-Hispanic White (NHW) populations by geographic region and Social Vulnerability Index (SVI) score. Incident cases diagnosed during 2010-2019 were identified from population-based cancer registries linked with the Indian Health Service patient registration databases. Age-adjusted incidence rates (per 100,000 population) for stomach, liver, and colorectal cancers were compared within NH-AI/AN populations and between the NH-AI/AN and NHW populations by SVI score. Rates were higher among NH-AI/AN populations in moderate- and high-SVI-score counties in Alaska, the Southern Plains, and the East than in low-SVI counties. Incidence rates among NH-AI/AN populations were elevated when compared with NHW populations by SVI category. Results indicated that higher social vulnerability may drive elevated cancer incidence among NH-AI/AN populations. Additionally, disparities between NH-AI/AN and NHW populations persist even when accounting for SVI. Exploring social vulnerability can aid in designing more effective interventions to address root causes of cancer disparities among AI/AN populations.
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Affiliation(s)
- Stephanie C. Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Melissa A. Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Avid Reza
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Lucy A. Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - Nathania Said
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
| | - J. Danielle Sharpe
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, United States (Stephanie C. Melkonian, Melissa A. Jim, Donald Haverkamp); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, United States (Avid Reza, Lucy A. Peipins); University of Chicago, Chicago, Illinois, United States (Nathania Said); and Geospatial Research, Analysis, and Services Program, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, United States (J. Danielle Sharpe)
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Conley CC, Derry-Vick HM, Ahn J, Xia Y, Lin L, Graves KD, Pan W, Fall-Dickson JM, Reeve BB, Potosky AL. Relationship between area-level socioeconomic status and health-related quality of life among cancer survivors. JNCI Cancer Spectr 2024; 8:pkad109. [PMID: 38128004 PMCID: PMC10868382 DOI: 10.1093/jncics/pkad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
Area-level socioeconomic status (SES) impacts cancer outcomes, such as stage at diagnosis, treatments received, and mortality. However, less is known about the relationship between area-level SES and health-related quality of life (HRQOL) for cancer survivors. To assess the additive value of area-level SES data and the relative contribution of area- and individual-level SES for estimating cancer survivors' HRQOL, we conducted a secondary analysis of data from a population-based survey study of cancer survivors (the Measuring Your Health [MY-Health] Study). Multilevel multinomial logistic regression models were used to examine the relationships between individual-level SES, area-level SES as measured by the Centers for Disease Control and Prevention's Social Vulnerability Index, and HRQOL group membership (high, average, low, or very low HRQOL). Area-level SES did not significantly increase model estimation accuracy compared to models using only individual-level SES. However, area-level SES could be an appropriate proxy when the individual-level SES is missing.
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Affiliation(s)
- Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Heather M Derry-Vick
- Cancer Prevention Precision Control Institute, Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Yi Xia
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Li Lin
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Wei Pan
- Health Statistics and Data Science Core, Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jane M Fall-Dickson
- Georgetown University School of Nursing, Georgetown University Medical Center, Washington, DC, USA
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bryce B Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Arnold L Potosky
- Department of Oncology, Georgetown University, Washington, DC, USA
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Pichardo CM, Dwyer LA, Ferrer RA, Oh AY. The Association of Context with Reported Self-Efficacy for Cancer-Preventive Behaviors and Perceived Cancer Risk in U.S. Adults from the Midlife in the United States (MIDUS) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:62. [PMID: 38248527 PMCID: PMC10815586 DOI: 10.3390/ijerph21010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Abstract
Background: Cancer is one of the leading causes of death in the United States. It is critical to understand the associations among multilevel determinants of cancer prevention and control behaviors. This study examined associations of neighborhood factors with perceived risk of cancer and self-efficacy for reducing cancer risk. Methods: Cross-sectional analyses included 2324 U.S. adults from the Midlife in the U.S. Wave 3. Participants completed surveys of neighborhood environment (perceived neighborhood trust and safety, built environment conditions, social integration), perceived cancer risk and cancer prevention efficacy. Multivariate linear regressions examined associations of neighborhood context with risk perceptions and self-efficacy. Results: In the model that adjusted for sociodemographic characteristics, better perceived neighborhood trust and safety were associated with lower perceived cancer risk. In fully adjusted models for sociodemographic characteristics and contextual factors, higher perceptions of neighborhood trust and safety were associated with higher cancer prevention self-efficacy. Perceptions of better built neighborhood conditions and higher social integration were significantly associated with lower perceived cancer risk and higher perceived cancer prevention efficacy. Conclusions: Perceptions of neighborhood context may play a role in shaping psychosocial factors such as perceived cancer risk and self-efficacy, even after controlling for robust predictors of these perceptions.
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Affiliation(s)
- Catherine M. Pichardo
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD 20892, USA;
| | | | - Rebecca A. Ferrer
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD 20892, USA;
| | - April Y. Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD 20892, USA;
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Kamil D, Wojcik KM, Smith L, Zhang J, Wilson OWA, Butera G, Jayasekera J. A Scoping Review of Personalized, Interactive, Web-Based Clinical Decision Tools Available for Breast Cancer Prevention and Screening in the United States. MDM Policy Pract 2024; 9:23814683241236511. [PMID: 38500600 PMCID: PMC10946080 DOI: 10.1177/23814683241236511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/04/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction. Personalized web-based clinical decision tools for breast cancer prevention and screening could address knowledge gaps, enhance patient autonomy in shared decision-making, and promote equitable care. The purpose of this review was to present evidence on the availability, usability, feasibility, acceptability, quality, and uptake of breast cancer prevention and screening tools to support their integration into clinical care. Methods. We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist to conduct this review. We searched 6 databases to identify literature on the development, validation, usability, feasibility, acceptability testing, and uptake of the tools into practice settings. Quality assessment for each tool was conducted using the International Patient Decision Aid Standard instrument, with quality scores ranging from 0 to 63 (lowest-highest). Results. We identified 10 tools for breast cancer prevention and 9 tools for screening. The tools included individual (e.g., age), clinical (e.g., genomic risk factors), and health behavior (e.g., alcohol use) characteristics. Fourteen tools included race/ethnicity, but no tool incorporated contextual factors (e.g., insurance, access) associated with breast cancer. All tools were internally or externally validated. Six tools had undergone usability testing in samples including White (median, 71%; range, 9%-96%), insured (99%; 97%-100%) women, with college education or higher (60%; 27%-100%). All of the tools were developed and tested in academic settings. Seven (37%) tools showed potential evidence of uptake in clinical practice. The tools had an average quality assessment score of 21 (range, 9-39). Conclusions. There is limited evidence on testing and uptake of breast cancer prevention and screening tools in diverse clinical settings. The development, testing, and integration of tools in academic and nonacademic settings could potentially improve uptake and equitable access to these tools. Highlights There were 19 personalized, interactive, Web-based decision tools for breast cancer prevention and screening.Breast cancer outcomes were personalized based on individual clinical characteristics (e.g., age, medical history), genomic risk factors (e.g., BRCA1/2), race and ethnicity, and health behaviors (e.g., smoking). The tools did not include contextual factors (e.g., insurance status, access to screening facilities) that could potentially contribute to breast cancer outcomes.Validation, usability, acceptability, and feasibility testing were conducted mostly among White and/or insured patients with some college education (or higher) in academic settings. There was limited evidence on testing and uptake of the tools in nonacademic clinical settings.
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Affiliation(s)
- Dalya Kamil
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M. Wojcik
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Laney Smith
- Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | | | - Oliver W. A. Wilson
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Avery J, Campbell KL, Mosher P, Al-Awamer A, Goddard K, Edwards A, Burnett L, Hannon B, Gupta A, Howard AF. Advanced Cancer in Young Adults (YAs): Living in a Liminal Space. QUALITATIVE HEALTH RESEARCH 2024; 34:72-85. [PMID: 37844970 PMCID: PMC10714712 DOI: 10.1177/10497323231204182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Young adults (YAs), defined as individuals between the ages of 18 and 39 years, experience unique challenges when diagnosed with advanced cancer. Using the social constructivist grounded theory approach, we aimed to develop a theoretical understanding of how YAs live day to day with their diagnosis. A sample of 25 YAs (aged 22-39 years) with advanced cancer from across Canada participated in semi-structured interviews. Findings illustrate that the YAs described day-to-day life as an oscillating experience swinging between two opposing disease outcomes: (1) hoping for a cure and (2) facing the possibility of premature death. Oscillating between these potential outcomes was characterized as living in a liminal space wherein participants were unsure how to live from one day to the next. The participants oscillated at various rates, with different factors influencing the rate of oscillation, including inconsistent and poor messaging from their oncologists or treatment team, progression or regression of their cancer, and changes in their physical functioning and mental health. These findings provide a theoretical framework for designing interventions to help YAs adapt to their circumstance.
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Affiliation(s)
- Jonathan Avery
- Anew Research Collaborative: Reshaping Young Adult Cancer Care, Royal Roads University, Victoria, BC, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Kristin L. Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Pamela Mosher
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Abha Gupta
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - A. Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Aggarwal A, Choudhury A, Fearnhead N, Kearns P, Kirby A, Lawler M, Quinlan S, Palmieri C, Roques T, Simcock R, Walter FM, Price P, Sullivan R. The future of cancer care in the UK-time for a radical and sustainable National Cancer Plan. Lancet Oncol 2024; 25:e6-e17. [PMID: 37977167 DOI: 10.1016/s1470-2045(23)00511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
Cancer affects one in two people in the UK and the incidence is set to increase. The UK National Health Service is facing major workforce deficits and cancer services have struggled to recover after the COVID-19 pandemic, with waiting times for cancer care becoming the worst on record. There are severe and widening disparities across the country and survival rates remain unacceptably poor for many cancers. This is at a time when cancer care has become increasingly complex, specialised, and expensive. The current crisis has deep historic roots, and to be reversed, the scale of the challenge must be acknowledged and a fundamental reset is required. The loss of a dedicated National Cancer Control Plan in England and Wales, poor operationalisation of plans elsewhere in the UK, and the closure of the National Cancer Research Institute have all added to a sense of strategic misdirection. The UK finds itself at a crossroads, where the political decisions of governments, the cancer community, and research funders will determine whether we can, together, achieve equitable, affordable, and high-quality cancer care for patients that is commensurate with our wealth, and position our outcomes among the best in the world. In this Policy Review, we describe the challenges and opportunities that are needed to develop radical, yet sustainable plans, which are comprehensive, evidence-based, integrated, patient-outcome focused, and deliver value for money.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ananya Choudhury
- Department of Clinical Oncology and Division of Cancer Sciences, The Christie NHS Foundation Trust, Manchester, UK
| | - Nicola Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pam Kearns
- Institute of Cancer and Genomic Sciences NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Kirby
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast Belfast, UK
| | | | - Carlo Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, & Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Tom Roques
- Royal College of Radiologists & Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Richard Simcock
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pat Price
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society & Public Health, King's College London, London, UK
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Robinson-Oghogho JN, Alcaraz KI, Thorpe RJ. Structural Racism as a Contributor to Lung Cancer Incidence and Mortality Rates Among Black Populations in the United States. Cancer Control 2024; 31:10732748241248363. [PMID: 38698674 PMCID: PMC11067682 DOI: 10.1177/10732748241248363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Although racial disparities in lung cancer incidence and mortality have diminished in recent years, lung cancer remains the second most diagnosed cancer among US Black populations. Many factors contributing to disparities in lung cancer are rooted in structural racism. To quantify this relationship, we examined associations between a multidimensional measure of county-level structural racism and county lung cancer incidence and mortality rates among Black populations, while accounting for county levels of environmental quality. METHODS We merged 2016-2020 data from the United States Cancer Statistics Data Visualization Tool, a pre-existing county-level structural racism index, the Environmental Protection Agency's 2006-2010 Environmental Quality Index (EQI), 2023 County Health Rankings, and the 2021 United States Census American Community Survey. We conducted multivariable linear regressions to examine associations between county-level structural racism and county-level lung cancer incidence and mortality rates. RESULTS Among Black males and females, each standard deviation increase in county-level structural racism score was associated with an increase in county-level lung cancer incidence of 6.4 (95% CI: 4.4, 8.5) cases per 100,000 and an increase of 3.3 (95% CI: 2.0, 4.6) lung cancer deaths per 100,000. When examining these associations stratified by sex, larger associations between structural racism and lung cancer rates were observed among Black male populations than among Black females. CONCLUSION Structural racism contributes to both the number of new lung cancer cases and the number of deaths caused by lung cancer among Black populations. Those aiming to reduce lung cancer cases and deaths should consider addressing racism as a root-cause.
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Affiliation(s)
- Joelle N. Robinson-Oghogho
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kassandra I. Alcaraz
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Roland J. Thorpe
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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