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Trejo E, Velazquez AI, Castillo E, Couey P, Cicerelli B, McBride R, Burke NJ, Dixit N. Acceptability and Feasibility of Survivorship Group Medical Visits for Breast Cancer Survivors in a Safety Net Hospital. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:445-454. [PMID: 38724720 PMCID: PMC11219419 DOI: 10.1007/s13187-024-02429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 07/03/2024]
Abstract
Providing cost-effective, comprehensive survivorship care remains a significant challenge. Breast cancer survivors (BCS) who have limited income and are from marginalized racial and ethnic groups experience a worse quality of life and report higher distress. Thus, innovative care models are required to address the needs of BCS in low resource settings. Group medical visits (GMV), utilized in chronic disease management, are an excellent model for education and building skills. This single-arm intervention study was conducted at a public hospital in California. GMVs consisted of five 2-h weekly sessions focused on survivorship care planning, side effects of treatment and prevention, emotional health, sexual health, physical activity, and diet. The patient navigators recruited three consecutive GMV groups of six English-speaking BCS (N = 17). A multidisciplinary team delivered GMVs, and a patient navigator facilitated all the sessions. We used attendance rates, pre- and post-surveys, and debriefing interviews to assess the feasibility and acceptability of the intervention. We enrolled 18 BCS. One participant dropped out before the intervention started, 17 BCS consistently attended and actively participated in the GMV, and 76% (13) attended all planned sessions. Participants rated GMVs in the post-survey and shared their support for GMVs in debriefing interviews. The BCS who completed the post-survey reported that GMVs increased their awareness, confidence, and knowledge of survivorship care. GMVs were explicitly designed to address unmet needs for services necessary for survivorship care but not readily available in safety net settings. Our pilot data suggest that patient-navigator-facilitated GMVs are a feasible and acceptable model for integrating survivorship care in public hospitals.
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Affiliation(s)
- Evelin Trejo
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Ana I Velazquez
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Elizabeth Castillo
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Paul Couey
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Barbara Cicerelli
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Robin McBride
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Nancy J Burke
- Department of Public Health, University of California Merced, Merced, CA, USA
| | - Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
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Torres P, Guitelman J, Lucio A, Rini C, Molina Y. Medical Advocacy among Latina Women Diagnosed with Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:495. [PMID: 38673406 PMCID: PMC11049890 DOI: 10.3390/ijerph21040495] [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: 01/22/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Medical advocacy has continued to significantly impact quality of life and survivorship outcomes among Latina breast cancer survivors in the United States. However, little is known about the unique experiences of Latina survivors, including the perceived value, process, and context in which they practice medical advocacy. To help address this gap, we conducted a qualitative, secondary analysis of semi-structured focus groups with 18 Latina breast cancer survivors from Chicago, Illinois. Eligible women had to self-identify as (1) female, (2) Latina, (3) 18 years or older, and (4) having a breast cancer diagnosis 5 years ago or more. In total, 61% of participants were 50-59 years old, 83% were born in Mexico, and 100% spoke Spanish. The three emergent themes from the focus groups were (1) the cultural need for Latina advocates and support groups; (2) the process and experiences of becoming a community advocate within Latine culture; and (3) the cultural contexts for advocacy by Latina breast cancer survivors. Latina survivor advocates share strengths of receiving ongoing health education, peer support, and access to resources when being linked to a support group furthering their exposure to role models, increasing their awareness of opportunities in medical advocacy, and providing an entry to participate in medical advocacy.
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Affiliation(s)
- Paola Torres
- University of Illinois Cancer Center, University of Illinois, Chicago, IL 60612, USA;
| | - Judith Guitelman
- Asociación Latina de Asistencia y Prevención del Cáncer de Mama (ALAS-WINGS), Chicago, IL 60657, USA;
| | | | - Christine Rini
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yamilé Molina
- University of Illinois Cancer Center, University of Illinois, Chicago, IL 60612, USA;
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL 60612, USA
- Hospital & Health Sciences Systems Mile Square Health Center, University of Illinois, Chicago, IL 60612, USA
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You KL, Sereika SM, Bender CM, Hamilton JB, Mazanec SR, Brufsky A, Rosenzweig MQ. Health-related quality of life over chemotherapy course among individuals with early-stage breast cancer: the association of social determinants of health and neighborhood socioeconomic disadvantage. Support Care Cancer 2024; 32:224. [PMID: 38472437 DOI: 10.1007/s00520-024-08429-y] [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: 08/31/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE This study aimed to examine relationships between health-related quality of life (HRQOL), social determinants of health, and neighborhood socioeconomic disadvantage in individuals with early-stage breast cancer (ESBC) during chemotherapy. METHODS This is a longitudinal study that recruited Black and White women with ESBC receiving chemotherapy. Participants completed questionnaires recording their sociodemographic information at baseline and the Functional Assessment of Cancer Therapy-General (FACT-G) to report their HRQOL before each chemotherapy cycle. Linear mixed modeling was employed to examine the associations between FACT-G scores, self-reported race, and area deprivation index (ADI) before and at the last chemotherapy cycle, with the duration of chemotherapy treatment as a covariate. RESULTS A total of 84 Black and 146 White women with ESBC completed the surveys. Linear mixed modeling results suggested that women with ESBC who reported being Black experienced significantly worse physical well-being than those who reported being White throughout chemotherapy, with a 0.22-point lower average (p = 0.02). Both Black and White women with ESBC experienced decreased functional well-being over the chemotherapy, and Black women consistently reported lower scores than White women, with the change in functional well-being over time differing between racial groups (p = 0.03). Participants' ADI national percentiles were not significantly associated with their HRQOL throughout chemotherapy. CONCLUSIONS These findings underscore possible racial differences in some dimensions of HRQOL during chemotherapy among women with ESBC. Future research should consider further assessing life stressors and past experiences of discrimination and racism that may contribute to these disparities and guide proactive interventions.
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Affiliation(s)
- Kai-Lin You
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, USA.
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, USA
| | - Catherine M Bender
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, USA
| | - Jill B Hamilton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Adam Brufsky
- Division of Hematology/Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Ye M, Kahana E, Deimling G, Perzynski A, Stange K. Beyond the treatment: The role of race, sex, and education in health trajectories between cancer survivors and noncancer older adults. J Geriatr Oncol 2023; 14:101532. [PMID: 37229884 PMCID: PMC10330899 DOI: 10.1016/j.jgo.2023.101532] [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: 12/29/2022] [Revised: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The number of older, long-term cancer survivors is increasing. However, little is known about how cancer and aging affect the health trajectories of older adults differently. In addition, the impact of race, sex, and education on the processes of aging and the cancer experience needs further investigation. The current study aims to address this knowledge gap by combining two National Cancer Institute (NIC)-funded longitudinal studies conducted in Cleveland from 1998 to 2010. MATERIALS AND METHODS The unique cross-sequential design facilitates a comparison between the health changes in long-term (five years +) older cancer survivors (breast, prostate, and colorectal cancer) and demographically matched older adults without a history of cancer in the same geographic area within the same period. The study also captured comprehensive information on how socioeconomic status interacts with cancer and aging over time. General linear models were employed in the data analysis. RESULTS The findings showed that early cancer experience did not affect long-term cancer survivors' health status in later life. Conversely, comorbidities, being an African American, being female, and having education less than a college degree significantly decreased the health trajectory in later life for all older adults. Moreover, compared to other groups, older African American cancer survivors reported a dramatic decrease in self-reported health after controlling for other conditions. DISCUSSION Study findings can inform public policy and social services to offer comprehensive treatment plans and help individuals overcome their diseases and lead longer and healthier lives.
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Affiliation(s)
- Minzhi Ye
- Kent State University The School of Lifespan Development and Educational Science, 111E, Nixson Hall, 1225 Theatre Drive, Kent, OH 44243, USA.
| | - Eva Kahana
- Case Western Reserve University Department of Sociology, Rm 226, Mather Memorial Building, 11220 Bellflower Rd, Cleveland, OH 44106, USA
| | - Gary Deimling
- Case Western Reserve University Department of Sociology, Rm 226, Mather Memorial Building, 11220 Bellflower Rd, Cleveland, OH 44106, USA
| | - Adam Perzynski
- The MetroHealth System Population Health Research Institute, 2500 Metrohealth Dr., Rammelkamp, Bldg., 2nd Floor, Cleveland, OH 44109, USA
| | - Kurt Stange
- Case Western Reserve University Center for Community Health Integration, School of Medicine 10900 Euclid Ave. Cleveland, OH 44106, USA
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