1
|
Oliveira ML, Biggers A, Oddo VM, Yanez B, Booms E, Sharp L, Naylor K, Wolf PG, Tussing-Humphreys L. A Perspective Review on Diet Quality, Excess Adiposity, and Chronic Psychosocial Stress and Implications for Early-Onset Colorectal Cancer. J Nutr 2024; 154:1069-1079. [PMID: 38453027 PMCID: PMC11007745 DOI: 10.1016/j.tjnut.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. Although the overall incidence of CRC has been decreasing over the past 40 y, early-onset colorectal cancer (EOCRC), which is defined as a CRC diagnosis in patients aged >50 y has increased. In this Perspective, we highlight and summarize the association between diet quality and excess adiposity, and EOCRC. We also explore chronic psychosocial stress (CPS), a less investigated modifiable risk factor, and EOCRC. We were able to show that a poor-quality diet, characterized by a high intake of sugary beverages and a Western diet pattern (high intake of red and processed meats, refined grains, and foods with added sugars) can promote risk factors associated with EOCRC development, such as an imbalance in the composition and function of the gut microbiome, presence of chronic inflammation, and insulin resistance. Excess adiposity, particularly obesity onset in early adulthood, is a likely contributor of EOCRC. Although the research is sparse examining CPS and CRC/EOCRC, we describe likely pathways linking CPS to tumorigenesis. Although additional research is needed to understand what factors are driving the uptick in EOCRC, managing body weight, improving diet quality, and mitigating psychosocial stress, may play an important role in reducing an individual's risk of EOCRC.
Collapse
Affiliation(s)
- Manoela Lima Oliveira
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States.
| | - Alana Biggers
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Vanessa M Oddo
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Emily Booms
- Department of Biology, Northeastern Illinois University, Chicago, IL, United States
| | - Lisa Sharp
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Keith Naylor
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Patricia G Wolf
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
2
|
Griffin JM, Kroner BL, Wong SL, Preiss L, Wilder Smith A, Cheville AL, Mitchell SA, Lancki N, Hassett MJ, Schrag D, Osarogiagbon RU, Ridgeway JL, Cella D, Jensen RE, Flores AM, Austin JD, Yanez B. Disparities in electronic health record portal access and use among patients with cancer. J Natl Cancer Inst 2024; 116:476-484. [PMID: 37930884 PMCID: PMC10919330 DOI: 10.1093/jnci/djad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Electronic health record-linked portals may improve health-care quality for patients with cancer. Barriers to portal access and use undermine interventions that rely on portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient and structural factors before the implementation of 3 portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. METHODS Portal use data were extracted from electronic health records for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs mobile), and number of clinical encounters before intervention implementation were also extracted. Rurality was derived using rural-urban commuting area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested the associations of these factors with portal access (ever accessed or never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs ≥21 weeks in the 35-week study period). RESULTS Of 28 942 eligible patients, 10 061 (35%) never accessed the portal. Male sex, membership in a racial and ethnic minority group, rural dwelling, not working, and limited broadband access were associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were associated with persistent portal use. CONCLUSION Patient and structural factors affect portal access and use and may exacerbate disparities in electronic health record-based cancer symptom surveillance and management.
Collapse
Affiliation(s)
- Joan M Griffin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Barbara L Kroner
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Liliana Preiss
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Deborah Schrag
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
3
|
Psihogios AM, Roth M, Gomez C, Hekimian-Brogan E, McQueen C, Yanez B. Partnering With Social Media Influencers to Equitably Improve Adolescent and Young Adult Cancer Outcomes: A Novel Strategy to Support Cancer Care Delivery. JCO Oncol Pract 2024:OP2300449. [PMID: 38408282 DOI: 10.1200/op.23.00449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/07/2024] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Affiliation(s)
| | - Michael Roth
- The University of Texas, MD Anderson Cancer Center, Houston, TX
| | | | | | | | | |
Collapse
|
4
|
Gong R, Heller A, Patricia I Moreno, Betina Yanez, Penedo FJ. Low Social Well-Being in Advanced and Metastatic Prostate Cancer: Effects of a Randomized Controlled Trial of Cognitive Behavioral Stress Management. Int J Behav Med 2024:10.1007/s12529-024-10270-w. [PMID: 38378974 DOI: 10.1007/s12529-024-10270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Social well-being impacts cancer patients' health-related quality of life (HRQOL) and coping style. This secondary analysis was conducted to examine whether advanced prostate cancer survivors who had experienced low social well-being would benefit from a web-based cognitive behavioral stress management (CBSM) intervention. METHOD APC survivors (N = 192) who had received androgen deprivation therapy (ADT) were randomized to a 10-week CBSM or a health promotion (HP) control condition. A subsample of participants (n = 61) with low pre-intervention SWB (measured by social support from and relationship satisfaction with family and friends) was included in the study. Multilevel models compared participants' PC-specific quality of life (sexual, hormonal, urinary), affect-based psychosocial burden (cancer-related anxiety and distress), and coping strategies at baseline, 6 months, and 12 months. Covariates were included in all models as appropriate. RESULTS Participants randomized to the CBSM condition showed significantly greater improvements in fear of cancer recurrence and cancer-related intrusive thoughts than those in the HP control condition. A significant condition by time interaction was also found, indicating that CBSM improved participants' PC-related fear in both short- (6 months) and long-term (12 months). However, the CBSM intervention did not significantly impact APC-related symptom burden. Only for the urinary domain, clinically meaningful changes (CBSM vs HP) were observed. In addition, all participants, regardless of condition, reported less coping (e.g., emotion-, problem- and avoidance-focused) over time. CONCLUSION As predicted, the CBSM intervention improved several affect-based psychosocial outcomes for APC survivors with low baseline SWB.
Collapse
Affiliation(s)
- Rui Gong
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Aaron Heller
- Department of Psychology, University of Miami, Coral Gables, Miami, FL, 33146, USA
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank J Penedo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
- Department of Psychology, University of Miami, Coral Gables, Miami, FL, 33146, USA.
| |
Collapse
|
5
|
Efficace F, Cottone F, Yanez B, Kota V, Castagnetti F, Caocci G, Bonifacio M, Patriarca A, Capodanno I, Miggiano MC, Tiribelli M, Breccia M, Luciano L, Giai V, Iurlo A, Abruzzese E, Fava C, Dinner S, Altman JK, Rosti G, Cortes J, Vignetti M, Cella D. Patient-reported symptom monitoring and adherence to therapy in patients with newly diagnosed chronic myeloid leukemia. Cancer 2024; 130:287-299. [PMID: 37801052 DOI: 10.1002/cncr.35021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The authors assessed the clinical utility of patient-reported symptom monitoring in the setting of newly diagnosed chronic myeloid leukemia (CML). The primary objective was to evaluate adherence to therapy. METHODS The authors conducted an international prospective study that included patients with newly diagnosed, chronic-phase CML. Before clinical consultation, patients were provided a tablet computer to self-rate their symptoms, and the results were available in real time to each physician during the patient's visit. Adherence was assessed by pill count and with a validated self-reported questionnaire. The proportions of optimal responders at 3 and 6 months were assessed according to the European LeukemiaNet criteria. RESULTS Between July 2020 and August 2021, 94 patients with a median age of 57 years were enrolled. Pill count adherence analysis indicated that 86 of 93 evaluable patients (92.5%) took at least 90% of prescribed tyrosine kinase inhibitor therapy during the 6-month observation period. The online platform was well accepted by patients and physicians. An optimal response was achieved by 69 of 79 patients (87.3%) at 3 months and by 61 of 81 patients (75.3%) at 6 months. CONCLUSIONS Patient-reported symptom monitoring from the beginning of therapy in patients with CML may be critical to improve adherence to therapy and early molecular response rates (ClinicalTrials.gov identifier NCT04384848).
Collapse
Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vamsi Kota
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | - Fausto Castagnetti
- Hematology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - Massimiliano Bonifacio
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, Verona, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, University of Udine, Udine, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Luigia Luciano
- Hematology Unit "Federico II,", University of Naples, Naples, Italy
| | - Valentina Giai
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Alessandra Iurlo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Abruzzese
- Hemoglobinopathies Unit, Hematology Department, S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica K Altman
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gianantonio Rosti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Jorge Cortes
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
6
|
Maras AF, Penedo FJ, Ramirez AG, Worch SM, Ortiz MS, Yanez B, Munoz E, Lad T, Hollowell C, Medina HN, Moreno PI. Correction to: Cardiometabolic comorbidities in Hispanic/Latino cancer survivors: prevalence and impact on health‑related quality of life and supportive care needs. Support Care Cancer 2023; 32:10. [PMID: 38055101 DOI: 10.1007/s00520-023-08217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Ashley F Maras
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Cancer Control Research Program, University of Miami, Miami, FL, USA
| | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, TX, USA
- Department of Population Health Sciences, UT Health San Antonio Long School of Medicine, San Antonio, TX, USA
| | - Sarah M Worch
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Manuel S Ortiz
- Department of Psychology, Universidad de La Frontera, Temuco, Chile
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edgar Munoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, TX, USA
| | - Thomas Lad
- Division of Hematology/Oncology, Cook County Health, Chicago, IL, USA
| | | | - Heidy N Medina
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Patricia I Moreno
- Sylvester Comprehensive Cancer Center, Cancer Control Research Program, University of Miami, Miami, FL, USA.
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.
- Don Soffer Clinical Research Center, University of Miami, 1120 NW 14Th Street, Miami, FL, 33136, USA.
| |
Collapse
|
7
|
Shahrour L, Martinez J, Chicaiza A, Omar R, Bovbjerg K, Stanton AL, Valdimarsdottir H, Yanez B, Munshi P, Rowley SD, Rini C, Graves KD. Greater Social Isolation and Social Constraints Prior to Hematopoietic Stem Cell Transplant Are Associated with Greater Anxiety and Depressive Symptoms. Int J Behav Med 2023:10.1007/s12529-023-10232-8. [PMID: 38017317 DOI: 10.1007/s12529-023-10232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (hereafter "HCT") is a physically and psychologically difficult treatment for patients with hematological cancers. This study examined relationships among patients' reports of pre-transplant social isolation, social constraints, and psychological distress. METHOD We used baseline data from a multisite randomized controlled trial evaluating the effects of expressive helping writing to reduce physical and emotional symptoms in HCT patients. We collected data prior to randomization and before either allogenic or autologous HCT using validated scales to assess social constraints, social isolation, anxiety, and depressive symptoms. We analyzed data using bivariate analysis and multivariate linear regression. We also explored whether social isolation mediated the effect of social constraints on both of our outcomes: anxiety and depressive symptoms. RESULTS Among 259 adults recruited prior to transplant, 43.6% were women (mean age = 57.42 years, SD = 12.34 years). In multivariate analysis controlling for relevant covariates, both social isolation (β = 0.24, p < 0.001) and social constraints (β = 0.28, p < 0.001) were associated with anxiety. When both social constraints and social isolation were in the model, only greater social isolation (β = 0.79, p < 0.001) was associated with depressive symptoms. Social isolation fully mediated the association between social constraints and anxiety and depressive symptoms. CONCLUSION For patients awaiting either allogenic or autologous HCT, the negative association between social constraints and anxiety and depressive symptoms may be related, in part, to the mechanism of perceived social isolation. Interventions prior to and during HCT are needed to support patients' psychological health and sense of social connectedness.
Collapse
Affiliation(s)
| | | | - Anthony Chicaiza
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C, USA
| | - Rahma Omar
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katrin Bovbjerg
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Heiddis Valdimarsdottir
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Pashna Munshi
- MedStar Georgetown University Hospital, Washington, D.C, USA
| | - Scott D Rowley
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Christine Rini
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Kristi D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C, USA.
| |
Collapse
|
8
|
Maras AF, Penedo FJ, Ramirez AG, Worch SM, Ortiz MS, Yanez B, Munoz E, Lad T, Hollowell C, Medina HN, Moreno PI. Cardiometabolic comorbidities in Hispanic/Latino cancer survivors: prevalence and impact on health-related quality of life and supportive care needs. Support Care Cancer 2023; 31:711. [PMID: 37982906 DOI: 10.1007/s00520-023-08181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE The aim of this study was to characterize the prevalence of cardiometabolic comorbidities (i.e., diabetes, peripheral vascular disease, myocardial infarction, congestive heart failure, cerebrovascular disease) among Hispanic/Latino cancer survivors and examine the impact of cardiometabolic comorbidities on health-related quality of life (HRQoL), unmet supportive care needs, patient-provider communication self-efficacy, satisfaction with cancer care, and increases in healthy behaviors. METHODS Hispanics/Latinos diagnosed with breast, prostate, or colorectal cancer (N = 288) were assessed within 15 months of primary treatment completion. RESULTS One-quarter (24.7%) of survivors were diagnosed with diabetes and one-fifth (20.8%) were diagnosed with peripheral vascular disease. Survivors with at least one cardiometabolic comoribidity were older (t(278) = -.3.622, p < .001) and more likely to have a household income of less than $25,000 (X2 = 8.369, p = .004). When adjusting for sociodemographic and medical covariates, survivors with cardiometabolic comorbidities demonstrated worse overall HRQoL (B = -4.792, p = .050), emotional (B = -1.479, p = .018) and physical (B = -2.228, p = .005) wellbeing, a higher odds of unmet psychological (OR = 2.095, p = .027) and sexuality (OR = 2.898, p = .004) needs, and greater patient-provider communication self-efficacy (B = .179, p = .045). There were no differences in healthy behavior changes or satisfaction with cancer care. CONCLUSIONS Cardiometabolic comorbidities may be highly prevalent among Hispanic/Latino cancer survivors and increase the risk of worse HRQoL and unmet supportive care needs. Targeted interventions are needed to optimize health among Hispanic/Latino cancer survivors with cardiometabolic comorbidities.
Collapse
Affiliation(s)
- Ashley F Maras
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Cancer Control Research Program, University of Miami, Miami, FL, USA
| | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, TX, USA
- Department of Population Health Sciences, UT Health San Antonio Long School of Medicine, San Antonio, TX, USA
| | - Sarah M Worch
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Manuel S Ortiz
- Department of Psychology, Universidad de La Frontera, Temuco, Chile
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Edgar Munoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, TX, USA
| | - Thomas Lad
- Division of Hematology/Oncology, Cook County Health, Chicago, IL, USA
| | | | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Patricia I Moreno
- Sylvester Comprehensive Cancer Center, Cancer Control Research Program, University of Miami, Miami, FL, USA.
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- University of Miami Don Soffer Clinical Research Center, 1120 NW 14Th Street, Miami, FL, 33136, USA.
| |
Collapse
|
9
|
Yanez B, Taub CJ, Waltz M, Diaz A, Buitrago D, Bovbjerg K, Chicaiza A, Thompson R, Rowley S, Moreira J, Graves KD, Rini C. Stem Cell Transplant Experiences Among Hispanic/Latinx Patients: A Qualitative Analysis. Int J Behav Med 2023; 30:628-638. [PMID: 36266388 PMCID: PMC9589807 DOI: 10.1007/s12529-022-10126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hispanic/Latinx (H/L) patients with cancer treated with stem cell transplant are vulnerable to adverse outcomes, including higher mortality. This study explored their unmet transplant needs, barriers, and facilitators. METHODS Eighteen English- or Spanish-speaking H/L patients (M age = 59.2) who had a transplant in the past year were interviewed about their transplant experience and rated their interest in receiving information about transplant topics (0 = not at all to 10 = extremely). RESULTS Content analysis revealed five main themes: (1) pre-transplant barriers and concerns; (2) complex relationships with medical teams; (3) informational mismatch; (4) impacts on daily life after transplant; and (5) methods of coping. Participants were most interested in information about ways of coping with transplant (M = 9.11, SD = 1.45) and words of hope and encouragement (M = 9.05, SD = 1.80). At just above the scale's midpoint, they were least interested in information about side effects and unintended consequences of transplant (M = 5.61, SD = 3.85). CONCLUSIONS Cultural factors, social determinants, and structural inequalities give rise to unique needs in this growing patient population. Healthcare team members and researchers can better meet the needs of H/L transplant recipients through attention to described considerations, such as financial barriers, communication difficulties, family dynamics, and coping styles.
Collapse
Affiliation(s)
- Betina Yanez
- Feinberg School of Medicine, Northwestern University, 625 North Michigan Ave, 21st Floor, IL, 60611, Chicago, USA.
| | - Chloe J Taub
- Feinberg School of Medicine, Northwestern University, 625 North Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
| | - Margaret Waltz
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Alma Diaz
- Feinberg School of Medicine, Northwestern University, 625 North Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
| | - Diana Buitrago
- Feinberg School of Medicine, Northwestern University, 625 North Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
| | - Katrin Bovbjerg
- Feinberg School of Medicine, Northwestern University, 625 North Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
| | - Anthony Chicaiza
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., USA
| | | | - Scott Rowley
- Hackensack University Medical Center, Hackensack, USA
- Georgetown University School of Medicine, Washington, D.C., USA
| | - Jonathan Moreira
- Feinberg School of Medicine, Northwestern University, 625 North Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
| | - Kristi D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., USA
| | - Christine Rini
- Feinberg School of Medicine, Northwestern University, 625 North Michigan Ave, 21st Floor, IL, 60611, Chicago, USA
| |
Collapse
|
10
|
Benzo RM, Moreno PI, Fox RS, Silvera CA, Walsh EA, Yanez B, Balise RR, Oswald LB, Penedo FJ. Comorbidity burden and health-related quality of life in men with advanced prostate cancer. Support Care Cancer 2023; 31:496. [PMID: 37501020 PMCID: PMC10644679 DOI: 10.1007/s00520-023-07962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Identifying clinically relevant comorbidities and their effect on health-related quality of life (HRQoL) outcomes among men with advanced prostate cancer (APC) can inform patient care and improve outcomes; however, this is poorly understood. The aim of this observational study was to examine the prevalence of comorbidities, and the relationship of comorbidity burden to HRQoL and other patient-reported outcomes (PROs) among men with APC. METHODS Participants were 192 men (average age 68.8) with APC (stage III or IV) who completed a psychosocial battery including measures of sociodemographic factors, HRQoL and other PROs, and the Charlson Comorbidity Index (CCI). Hierarchical multiple regression analysis was used to examine the relationships between CCI, HRQOL, and PROs. RESULTS The vast majority (82%) of participants had at least one comorbidity, with the most common being: hypertension (59%), connective tissue disease or arthritis (31%), diabetes (24%), and problems with kidneys, vision, or another organ (24%). After controlling for covariates, regressions showed that a higher CCI score was significantly associated with worse HRQoL (p < 0.001), lower levels of positive affect (p < 0.05), and higher levels of depression (p < 0.05), fatigue (p < 0.001), pain (p < 0.01), stress (p < 0.01), and cancer-specific distress (p < 0.05). CONCLUSIONS Comorbidities were common among men with APC, and a greater CCI score was associated with detriments in several domains of HRQoL and other PROs. Our findings show the need to address comorbidities in the presence of a cancer diagnosis and subsequent treatment. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER NCT03149185.
Collapse
Affiliation(s)
- Roberto M Benzo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rina S Fox
- University of Arizona College of Nursing, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carlos A Silvera
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Raymond R Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Urology, University of Miami, Miami, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffit Cancer Center, Tampa, FL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5thFloor, Coral Gables, Miami, FL, 33146, USA.
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
| |
Collapse
|
11
|
Cella D, Garcia SF, Cahue S, Smith JD, Yanez B, Scholtens D, Lancki N, Bass M, Kircher S, Flores AM, Jensen RE, Smith AW, Penedo FJ. Implementation and evaluation of an expanded electronic health record-integrated bilingual electronic symptom management program across a multi-site Comprehensive Cancer Center: The NU IMPACT protocol. Contemp Clin Trials 2023; 128:107171. [PMID: 36990275 PMCID: PMC10164083 DOI: 10.1016/j.cct.2023.107171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/25/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND People with cancer experience symptoms that adversely affect quality of life. Despite existing interventions and clinical guidelines, timely symptom management remains uneven in oncology care. We describe a study to implement and evaluate an electronic health record (EHR)-integrated symptom monitoring and management program in adult outpatient cancer care. METHODS Our cancer patient-reported outcomes (cPRO) symptom monitoring and management program is a customized EHR-integrated installation. We will implement cPRO across all Northwestern Memorial HealthCare (NMHC) hematology/oncology clinics. We will conduct a cluster randomized modified stepped-wedge trial to evaluate patient and clinician engagement with cPRO. Further, we will embed a patient-level randomized clinical trial to evaluate the impact of an additional enhanced care (EC; cPRO plus web-based symptom self-management intervention) relative to usual care (UC; cPRO alone). The project uses a Type 2 hybrid effectiveness-implementation approach. The intervention will be implemented across seven regional clusters within the healthcare system comprising 32 clinic sites. A 6-month prospective pre-implementation enrollment period will be followed by a post-implementation enrollment period, during which newly enrolled, consenting patients will be randomly assigned (1:1) to EC or UC. We will follow patients for 12 months post-enrollment. Patients randomized to EC will receive evidence-based symptom-management content on cancer-related concerns and approaches to enhance quality of life, using a web-based tool ("MyNM Care Corner"). This design allows for within- and between-site evaluation of implementation plus a group-based comparison to demonstrate effectiveness on patient-level outcomes. DISCUSSION The project has potential to guide implementation of future healthcare system-level cancer symptom management programs. http://ClinicalTrials.gov # NCT03988543.
Collapse
Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America.
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America.
| | - September Cahue
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, United States of America.
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Michael Bass
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Sheetal Kircher
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America; Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Roxanne E Jensen
- Outcomes Research Branch Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America.
| | - Ashley Wilder Smith
- Outcomes Research Branch Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States of America; Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, FL, United States of America.
| |
Collapse
|
12
|
Walsh EA, Boland CL, Popok PJ, Pedreira PB, Fox RS, Moreno PI, Yanez B, Penedo FJ. Marital status and perceived stress in men with advanced prostate cancer: A randomized-controlled trial of cognitive behavioral stress management. J Psychosom Res 2023; 167:111198. [PMID: 36812663 PMCID: PMC10023351 DOI: 10.1016/j.jpsychores.2023.111198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Relationship status predicts numerous outcomes among medical populations. Few interventions evaluate the role of marital status on response to psychosocial treatment, and no such studies exist within advanced prostate cancer (APC). This study examined whether marital status modified the effect of a cognitive behavioral stress management (CBSM) intervention on perceived stress. METHODS Men with APC (N = 190) were randomized to 10-week CBSM or a health promotion (HP) intervention (#NCT03149185). The Perceived Stress Scale assessed perceived stress at baseline and 12-month follow-up. Medical status and sociodemographics were captured at enrollment. RESULTS Participants were mostly White (59.5%), non-Hispanic (97.4%), heterosexual (97.4%) men, 66.8% of whom were partnered. Neither condition nor marital status predicted perceived stress change at follow-up. However, a significant interaction was found between condition and marital status (p = 0.014; Cohen's f = 0.07), such that partnered men who received CBSM and unpartnered men who received HP reported greater reductions in perceived stress. CONCLUSION This is the first study to assess the impact of marital status on psychosocial intervention effects among men with APC. Partnered men derived greater benefit from a cognitive-behavioral intervention and unpartnered men equally benefitted from a HP intervention. Further research is necessary to understand the mechanisms underlying these relationships.
Collapse
Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, Coral Gables, FL, United States of America.
| | - Cody L Boland
- Department of Psychology, University of Miami, Coral Gables, FL, United States of America
| | - Paula J Popok
- Department of Psychology, University of Miami, Coral Gables, FL, United States of America
| | - Patricia B Pedreira
- Department of Psychology, University of Miami, Coral Gables, FL, United States of America
| | - Rina S Fox
- University of Arizona, College of Nursing, Tucson, AZ, United States of America
| | - Patricia I Moreno
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, United States of America; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, United States of America; University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, United States of America
| |
Collapse
|
13
|
Yanez B, Czech KA, Buitrago D, Smith JD, Schueller SM, Taub CJ, Kircher S, Garcia SF, Bass M, Mercer AM, Silvera CA, Scholtens D, Peipert JD, Psihogios AM, Duffecy J, Cella D, Antoni MH, Penedo FJ. Effectiveness and implementation of an electronic health record-integrated digital health intervention for managing depressive symptoms in ambulatory oncology: The My Well-Being Guide study rationale and protocol. Contemp Clin Trials 2023; 127:107121. [PMID: 36805073 PMCID: PMC10846504 DOI: 10.1016/j.cct.2023.107121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Rates of clinically elevated depressive symptoms among ambulatory oncology patients are higher than in the general population and are associated with poorer health-related quality of life. Furthermore, a reduction in depressive symptoms may be associated with improved cancer survival. Several interventions have demonstrated efficacy in reducing oncologic depressive symptoms, including cognitive-behavioral stress management (CBSM). However, more work is needed to understand how to best implement CBSM into practice, such as through stepped-care approaches and digital health interventions linked to electronic health records (EHR). This manuscript presents the protocol of the My Well-Being Guide study, a pragmatic type 1 effectiveness-implementation hybrid study. This trial will test the effectiveness of My Well-Being Guide, a seven-week structured, CBSM-based digital health intervention designed to reduce depressive symptoms. This trial will also evaluate My Well-Being Guide's implementation across two health systems. METHODS The final sample (N = 4561) will be oncology patients at Northwestern Medicine or University of Miami Health System who are ≥18 years of age; have a cancer diagnosis; elevated depressive symptoms on the Patient-Reported Outcomes Measurement Information System Depression; and primary language is English or Spanish. Data collection will occur at baseline, and 2-, 6-, and 12-months post baseline. Outcome domains include depressive symptoms and implementation evaluation. DISCUSSION This study may provide valuable data on the effectiveness of our depressive symptom management digital health intervention linked to the EHR and the scalability of digital health interventions in general.
Collapse
Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Katherine A Czech
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, United States of America
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, CA, United States of America
| | - Chloe J Taub
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Sheetal Kircher
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America
| | - Michael Bass
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ambrosine M Mercer
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Carlos A Silvera
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, FL, United States of America
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Alexandra M Psihogios
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois Chicago, Chicago, IL, United States of America
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Michael H Antoni
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States of America; Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America; Department of Psychology, University of Miami, Coral Gables, FL, United States of America
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States of America; Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, FL, United States of America
| |
Collapse
|
14
|
Benzo R, Moreno PI, Fox RS, Silvera CA, Walsh EA, Yanez B, Balise RR, Oswald LB, Penedo FJ. Comorbidity burden and health-related quality of life in men with advanced prostate cancer. Res Sq 2023:rs.3.rs-2572781. [PMID: 36824747 PMCID: PMC9949262 DOI: 10.21203/rs.3.rs-2572781/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Purpose: Identifying clinically relevant comorbidities and their effect on health-related quality of life (HRQoL) outcomes among men with advanced prostate cancer (APC) can inform patient care and improve outcomes; however, this is poorly understood. The aim of this observational study was to examine the prevalence of comorbidities, and the relationship of comorbidity burden to HRQoL and other patient-reported outcomes (PROs) among men with APC. Methods: Participants were 192 men (average age 68.8) with APC (stage III or IV) who completed a psychosocial battery including measures of sociodemographic factors, HRQoL and other PROs, and the Charlson Comorbidity Index (CCI). Hierarchical multiple regression analysis was used to examine the relationships between CCI, HRQOL, and PROs. Results: The vast majority (82%) of participants had at least one comorbidity, with the most common being: hypertension (59%), connective tissue disease or arthritis (31%), diabetes (24%), and problems with kidneys, vision, or another organ (24%). After controlling for covariates, regressions showed that a higher CCI score was significantly associated with worse HRQoL ( p < 0.001), lower levels of positive affect ( p < 0.05), and higher levels of depression ( p < 0.05), fatigue ( p < 0.001), pain ( p < 0.01), stress ( p < 0.01), and cancer-specific distress ( p < 0.05). Conclusions: Comorbidities were common among men with APC, and a greater CCI score was associated with detriments in several domains of HRQoL and other PROs. Our findings show the need to address comorbidities in the presence of a cancer diagnosis and subsequent treatment.
Collapse
Affiliation(s)
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | | | | | | | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Raymond R Balise
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffit Cancer Center
| | | |
Collapse
|
15
|
Griffin JM, Wong SL, Yanez B, Kroner B, Preiss L, Jensen RE, Wilder Smith A, Popovic J, Austin J, Flores AM, Mitchell S, Bian J, Hassett MJ, Osarogiagbon R, Cheville AL. Predictors of electronic health record (EHR) portal registration and frequency of portal use among patients with cancer prior to engagement in the IMPACT Consortium symptom management trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
419 Background: The patient portal is part of an electronic health record (EHR) that allows patients to communicate with their healthcare team. The portal also provides a platform for patients to receive and complete symptom surveys that can be directly integrated into the EHR, allowing clinical care teams to monitor symptoms and provide cancer symptom management. The Improving Management of symPtoms during And following Cancer Treatment (IMPACT) consortium, supported by the National Cancer Institute’s Cancer MoonshotSM, aims to improve symptom control for cancer patients through assessment and symptom management interventions deployed via the EHR. This initiative presents an opportunity to examine portal enrollment and variation in use, factors critical to successful implementation, especially among groups that have high cancer symptom burden. To this end, we examine: 1) relationships between portal enrollment prior to the launch of IMPACT interventions and neighborhood broadband access, demographic, and social characteristics; and 2) frequency of pre-intervention portal use for any purpose among enrollees. Methods: Data are derived from two of three IMPACT research centers. Enrollment in and frequency of portal use, mode of accessing the portal (web vs. phone), social, demographic, and cultural factors were extracted from the EHR. Rural Urban Commuting Area (RUCA) codes were used to classify population density and degree of rurality. Broadband access was estimated using 2015-2019 American Community Survey estimates matched to zip codes from enrolled IMPACT patients and classified as a patient’s residence being in a community with high (≥85% of households) or low (< 85% of households) access. Bivariate comparisons and adjusted odds ratios were used to describe all associations. Results: Forty-seven percent of patients (22,596/48,034) were enrolled in the portal prior to the intervention. Patients in zip codes with low broadband access and those who were men, > 65 years old, not White, of Hispanic ethnicity, or disabled or not employed had significantly lower odds of being enrolled in the portal. If enrolled, 21% (n = 4825) used the portal at least once a week. Less variation was found in the average frequency of portal use, but patients younger than 40, and those who were Black, disabled, unemployed, or those who used a mobile device to access the portal had the lowest odds of accessing it at least once a week. Conclusions: Significant disparities in portal enrollment exist across demographic groups and among those with limited broadband access. Among those enrolled, most used the portal less than once a week. Fewer differences in frequency of use were observed by sociodemographic factors. Improving portal enrollment and frequency of use may be critical for symptom management interventions deployed via patient portals.
Collapse
Affiliation(s)
| | | | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Perry LM, Morken V, Peipert JD, Yanez B, Garcia SF, Barnard C, Hirschhorn LR, Linder JA, Jordan N, Ackermann RT, Harris A, Kircher S, Mohindra N, Aggarwal V, Frazier R, Coughlin A, Bedjeti K, Weitzel M, Nelson EC, Elwyn G, Van Citters AD, O'Connor M, Cella D. Patient-Reported Outcome Dashboards Within the Electronic Health Record to Support Shared Decision-making: Protocol for Co-design and Clinical Evaluation With Patients With Advanced Cancer and Chronic Kidney Disease. JMIR Res Protoc 2022; 11:e38461. [PMID: 36129747 PMCID: PMC9536520 DOI: 10.2196/38461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported outcomes-symptoms, treatment side effects, and health-related quality of life-are important to consider in chronic illness care. The increasing availability of health IT to collect patient-reported outcomes and integrate results within the electronic health record provides an unprecedented opportunity to support patients' symptom monitoring, shared decision-making, and effective use of the health care system. OBJECTIVE The objectives of this study are to co-design a dashboard that displays patient-reported outcomes along with other clinical data (eg, laboratory tests, medications, and appointments) within an electronic health record and conduct a longitudinal demonstration trial to evaluate whether the dashboard is associated with improved shared decision-making and disease management outcomes. METHODS Co-design teams comprising study investigators, patients with advanced cancer or chronic kidney disease, their care partners, and their clinicians will collaborate to develop the dashboard. Investigators will work with clinic staff to implement the co-designed dashboard for clinical testing during a demonstration trial. The primary outcome of the demonstration trial is whether the quality of shared decision-making increases from baseline to the 3-month follow-up. Secondary outcomes include longitudinal changes in satisfaction with care, self-efficacy in managing treatments and symptoms, health-related quality of life, and use of costly and potentially avoidable health care services. Implementation outcomes (ie, fidelity, appropriateness, acceptability, feasibility, reach, adoption, and sustainability) during the co-design process and demonstration trial will also be collected and summarized. RESULTS The dashboard co-design process was completed in May 2020, and data collection for the demonstration trial is anticipated to be completed by the end of July 2022. The results will be disseminated in at least one manuscript per study objective. CONCLUSIONS This protocol combines stakeholder engagement, health care coproduction frameworks, and health IT to develop a clinically feasible model of person-centered care delivery. The results will inform our current understanding of how best to integrate patient-reported outcome measures into clinical workflows to improve outcomes and reduce the burden of chronic disease on patients and health care systems. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38461.
Collapse
Affiliation(s)
- Laura M Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Victoria Morken
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - John D Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cynthia Barnard
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert J Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, United States
| | - Ronald T Ackermann
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alexandra Harris
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheetal Kircher
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nisha Mohindra
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Vikram Aggarwal
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca Frazier
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ava Coughlin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Melissa Weitzel
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Mary O'Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
17
|
Rini C, Waltz M, Bovbjerg K, Farrell D, Yanez B, Chicaiza A, Hartstein ML, Omar R, Thompson R, Rowley SD, Stanton AL, Valdimarsdottir H, Austin J, Van Denburg AN, Graves KD. Optimizing use of Written Peer Support as a Supportive Resource in Cancer: FOCUS GROUP INSIGHTS. Psychooncology 2022; 31:1589-1596. [PMID: 35765696 PMCID: PMC9452473 DOI: 10.1002/pon.5991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/13/2022] [Accepted: 06/24/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Cancer survivors frequently describe wanting to learn from others who have had similar diagnoses or treatments (peer support). We conducted focus groups to investigate hematopoietic stem cell transplant survivors' attitudes and preferences regarding accessing written peer support through a website. Although written peer support does not allow for interpersonal interactions with peers, it could increase transplant recipients' access to evidence-based benefits of informational and emotional peer support. METHODS We conducted four videoconference focus groups with 34 adult transplant survivors who were diverse in their medical and sociodemographic characteristics and geographic location. Discussions were recorded, transcribed, and content analyzed. RESULTS Many participants reported need for information about transplant beyond what they received from their healthcare providers. Needs varied across participants, as did preferences for characteristics and timing of information optimally provided through peer support. Participants were enthusiastic about the value of written peer support but emphasized that it should be delivered in a way that accommodates variation in transplant experiences, underscores its trustworthiness, and pairs it with useful psychoeducational content. CONCLUSIONS Findings provide guidance for making written peer support an accessible, supportive resource for transplant survivors. Future research should evaluate personalized online delivery of written peer support paired with psychoeducational content that enhances its benefits. IMPLICATIONS FOR CANCER SURVIVORS Written peer support delivered online could be a useful, valued resource for transplant survivors. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Christine Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Margaret Waltz
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Katrin Bovbjerg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Anthony Chicaiza
- Department of Oncology, Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Madison L Hartstein
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rahma Omar
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rebecca Thompson
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Scott D Rowley
- Department of Oncology, Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA.,John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Annette L Stanton
- Department of Psychiatry/Biobehavioral Science, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Psychology, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Heiddis Valdimarsdottir
- Department of Psychology, Reykjavik University, Reykjavík, Iceland.,Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane Austin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
| | - Alyssa N Van Denburg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| |
Collapse
|
18
|
Yanez B, Peipert J, Garcia SF, Mai QH, Lancki N, Buitrago D, Taub CJ, Jensen RE, Smith JD, Penedo FJ, Cella D, Kircher SM. Association of modifiable factors with financial burden and health literacy among patients with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6573 Background: Cancer patients are at a higher risk of financial burden compared to those with other chronic illnesses and those without cancer. Additionally, cancer patients with low health literacy are at risk for poor health outcomes and poor self-management. Aside from factors such as education and insurance, there is limited information on the role of modifiable factors in predicting financial burden and health literacy. The aim of this study was to identify risk factors associated with financial burden and health literacy among cancer patients. Methods: Participants were 2,260 adult, English- or Spanish-speaking patients who were recruited from an NCI-designated cancer center in the Chicagoland area as part of a trial on symptom management. Participants completed measures on depressive symptoms and anxiety using the Patient-Reported Outcomes Measurement Information System (PROMIS). Financial burden was assessed using a Comprehensive Score for Financial Toxicity (COST FACIT) item (FT12) and health literacy was assessed by the Single Item Literacy Screener (SILS). Additional information on insurance and cancer diagnosis were extracted from medical records. The area deprivation index (ADI) was calculated using national percentile rankings for the patient’s block group. All patient-reported outcomes were assessed at study baseline. Cross-sectional logistic regression models were fit with the FT12 item [dichotomized as high (somewhat/quite a bit/very much) vs. low (not at all/a little bit) financial burden] and SILS [dichotomized as high (quite a bit/extremely) vs. low (not at all/a little bit/somewhat) health literacy] as separate outcomes. The primary covariates of interest were anxiety and depressive symptoms T-scores (dichotomized reflect normal limits vs. elevated distress). Analyses were adjusted for socio-demographic and clinical characteristics. Results: After adjusting for covariates, significant associations of greater financial burden were PROMIS depression [odds ratio (OR): 1.63 (95% CI: 1.22-2.19)] and PROMIS anxiety (OR: 1.60; 95% CI: 1.22-2.10). In addition, higher ADI score, lower education, unemployment, and low health literacy were significantly associated with greater financial burden. PROMIS depression (OR: 2.15; 95% CI: 1.38-3.40) was associated with low heath literacy, along with disability/leave of absence, Medicare/Medicaid/uninsured and lower education. Conclusions: Modifiable factors are associated with financial burden and health literacy. These results support the systematic screening for financial burden and health literacy in addition emotional well-being. Interventions targeting the modifiable factors elucidated in this study may further efforts to provide quality and equitable comprehensive cancer care. Future work should evaluate the potential causal pathways between depression, health literacy, and financial burden.
Collapse
Affiliation(s)
- Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sofia F. Garcia
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | |
Collapse
|
19
|
Sadigh G, Gray RJ, Sparano JA, Yanez B, Garcia SF, Timsina LR, Obeng-Gyasi S, Gareen I, Sledge GW, Whelan TJ, Cella D, Wagner LI, Carlos RC. Assessment of Racial Disparity in Survival Outcomes for Early Hormone Receptor-Positive Breast Cancer After Adjusting for Insurance Status and Neighborhood Deprivation: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Oncol 2022; 8:579-586. [PMID: 35175284 PMCID: PMC8855314 DOI: 10.1001/jamaoncol.2021.7656] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Racial disparities in survival outcomes among Black women with hormone receptor-positive breast cancer have been reported. However, the association between individual-level and neighborhood-level social determinants of health on such disparities has not been well studied. OBJECTIVE To evaluate the association between race and clinical outcomes (ie, relapse-free interval and overall survival) adjusting for individual insurance coverage and neighborhood deprivation index (NDI), measured using zip code of residence, in women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS This was a post hoc analysis of 9719 women with breast cancer in the Trial Assigning Individualized Options for Treatment, a randomized clinical trial conducted from April 7, 2006, to October 6, 2010. All participants received a diagnosis of hormone receptor-positive, ERBB2-negative, axillary node-negative breast cancer. The present data analysis was conducted from April 1 to October 22, 2021. MAIN OUTCOMES AND MEASURES A multivariate model was developed to evaluate the association between race and relapse-free interval and overall survival adjusting for insurance and NDI level at study entry, early discontinuation of endocrine therapy 4 years after initiation, and clinicopathologic characteristics of cancer. Median follow-up for clinical outcomes was 96 months. RESULTS A total of 9719 women (4.2% [n = 405] Asian; 7.1% [n = 693] Black; 84.3% [n = 8189] White; 4.4% [n = 403] others/not specified) were included; 9.1% of included women [n = 889] were Hispanic or Latino. Median (SD) age was 56 (9.2) years. In multivariate models, Black race compared with White race was associated with statistically significant shorter relapse-free interval (hazard ratio [HR], 1.39; 95% CI, 1.05-1.84; P = .02) and overall survival (HR, 1.49; 95% CI, 1.10-2.99; P = .009), adjusting for insurance and NDI level at study entry and other factors. Although uninsured status was not associated with clinical outcomes, patients with Medicare (HR, 1.30; 95% CI, 1.01-1.68; P = .04) and Medicaid (HR, 1.44; 95% CI, 1.01-2.05; P = .05) had shorter overall survival compared with those with private insurance. Participants living in neighborhoods in the highest NDI quartile experienced shorter overall survival compared with those in the lowest quartile (HR, 1.34; 95% CI, 1.01-1.77; P = .04), regardless of self-identified race. CONCLUSIONS AND RELEVANCE The findings of this post hoc analysis of a randomized clinical trial suggest that Black women with breast cancer have significantly shorter relapse-free interval and overall survival compared with White women. Early discontinuation of endocrine therapy, clinicopathologic characteristics, insurance coverage, and NDI do not fully explain the observed disparity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00310180.
Collapse
Affiliation(s)
- Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Robert J. Gray
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Joseph A. Sparano
- Department of Hematology and Oncology, The Mount Sinai Hospital, New York, New York
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sofia F. Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lava R. Timsina
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus
| | - Ilana Gareen
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | | | - Timothy J. Whelan
- Canadian Cancer Trials Group, McMaster University, Hamilton, Ontario, Canada
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynne I. Wagner
- Wake Forest University Health Sciences, Winston Salem, North Carolina
| | - Ruth C. Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor
| |
Collapse
|
20
|
Noriega Esquives B, Lee TK, Moreno PI, Fox RS, Yanez B, Miller GE, Estabrook R, Begale MJ, Flury SC, Perry K, Kundu SD, Penedo FJ. Symptom burden profiles in men with advanced prostate cancer undergoing androgen deprivation therapy. J Behav Med 2022; 45:366-377. [PMID: 35107655 DOI: 10.1007/s10865-022-00288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
To identify symptom burden profiles among men with advanced prostate cancer undergoing androgen-deprivation therapy and examine their association with baseline sociodemographic and medical characteristics and psychosocial outcomes over time. Latent profile analysis was employed to identify distinct groups based on the Expanded Prostate Index Composite and the McGill Pain Questionnaire at baseline. Psychosocial outcomes were assessed at baseline, 6- and 12-month follow-ups. Three profiles emerged: "high symptom burden," "high sexual bother," and "low symptom burden." Men with "high symptom burden" were younger and exhibited higher baseline levels of depression, stress, cancer-specific distress, and anxiety than men in the other two groups. However, men with "high symptom burden" also demonstrated improvement in these psychosocial outcomes over time. Men with advanced prostate cancer who experience multiple co-occurring symptoms demonstrate worse psychosocial adjustment. Patients with substantial symptom burden, and specifically young men, may benefit from prompt referral to supportive care services.
Collapse
Affiliation(s)
- Blanca Noriega Esquives
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1006, Miami, FL, 33136, USA.
| | - Tae K Lee
- Department of Convergence for Social Innovation, Department of Child Psychology and Education, Sungkyunkwan University, Seoul, South Korea
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1006, Miami, FL, 33136, USA
| | - Rina S Fox
- College of Nursing, University of Arizona, Tucson, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Gregory E Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, USA
| | - Ryne Estabrook
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, USA
| | | | - Sarah C Flury
- Department of Urology, Vanderbilt University School of Medicine, Nashville, USA
| | - Kent Perry
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Shilajit D Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| |
Collapse
|
21
|
Garcia SF, Gray RJ, Sparano JA, Tevaarwerk AJ, Carlos RC, Yanez B, Gareen IF, Whelan TJ, Sledge GW, Cella D, Wagner LI. Fatigue and endocrine symptoms among women with early breast cancer randomized to endocrine versus chemoendocrine therapy: Results from the TAILORx patient-reported outcomes substudy. Cancer 2022; 128:536-546. [PMID: 34614209 PMCID: PMC8776586 DOI: 10.1002/cncr.33939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/17/2021] [Accepted: 07/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND TAILORx (Trial Assigning Individualized Options for Treatment) prospectively assessed fatigue and endocrine symptoms among women with early-stage hormone receptor-positive breast cancer and a midrange risk of recurrence who were randomized to endocrine therapy (E) or chemotherapy followed by endocrine therapy (CT+E). METHODS Participants completed the Functional Assessment of Chronic Illness Therapy-Fatigue, the Patient-Reported Outcomes Measurement Information System-Fatigue Short Form, and the Functional Assessment of Cancer Therapy-Endocrine Symptoms at the baseline and at 3, 6, 12, 24, and 36 months. Linear regression was used to model outcomes on baseline symptoms, treatment, and other factors. RESULTS Participants (n = 458) in both treatment arms reported greater fatigue and endocrine symptoms at early follow-up in comparison with the baseline. The magnitude of change in fatigue was significantly greater for the CT+E arm than the E arm at 3 and 6 months but not at 12, 24, or 36 months. The CT+E arm reported significantly greater changes in endocrine symptoms from the baseline to 3 months in comparison with the E arm; change scores were not significantly different at later time points. Endocrine symptom trajectories by treatment differed by menopausal status, with the effect larger and increasing for postmenopausal patients. CONCLUSIONS Adjuvant CT+E was associated with greater increases in fatigue and endocrine symptoms at early time points in comparison with E. These differences lessened over time, and this demonstrated early chemotherapy effects more than long-term ones. Treatment arm differences in endocrine symptoms were more evident in postmenopausal patients. LAY SUMMARY Participants in TAILORx (Trial Assigning Individualized Options for Treatment) with early-stage hormone receptor-positive breast cancer and an intermediate risk of recurrence were randomly assigned to endocrine or chemoendocrine therapy. Four hundred fifty-eight women reported fatigue and endocrine symptoms at the baseline and at 3, 6, 12, 24, and 36 months. Both groups reported greater symptoms at early follow-up versus the baseline. Increases in fatigue were greater for the chemoendocrine group than the endocrine group at 3 and 6 months but not later. The chemoendocrine group reported greater changes in endocrine symptoms in comparison with the endocrine group at 3 months but not later.
Collapse
Affiliation(s)
| | - Robert J. Gray
- Dana Farber Cancer Institute
- ECOG-ACRIN Biostatistics Center
| | | | | | | | | | - Ilana F. Gareen
- Center for Statistical Sciences & Department of Epidemiology, Brown University School of Public Health
- Center for Statistical Sciences & Department of Epidemiology, Brown University School of Public Health
| | | | | | | | | |
Collapse
|
22
|
Bovbjerg K, Graves K, Waltz M, Farrell D, Yanez B, Chicaiza A, Omar R, Thompson R, Kop M, Van Denburg AN, Lorch D, Rowley SD, Rini C. Expanding access to cancer peer support: development of a website to deliver written peer support that meets patients' individual emotional and informational needs while reducing potential harms. Procedia Comput Sci 2022; 206:195-205. [PMID: 36567868 PMCID: PMC9788802 DOI: 10.1016/j.procs.2022.09.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cancer patients often want information from "peers" with the same diagnosis or treatment. To increase access to this valuable resource, we developed a website to deliver written peer support to cancer patients undergoing stem cell transplant. Because little evidence describes how to optimize benefits or reduce potential harms of written peer support, we gathered multiple forms of stakeholder feedback to inform the website's ethical approach, personalization, design, function, and content: a Community Advisory Board; a longitudinal study of patients' written peer support needs and motivations; focus groups; semi-structured interviews; and usability testing. Findings provide a rich foundation for website development.
Collapse
Affiliation(s)
- Katrin Bovbjerg
- Northwestern University Feinberg School of Medicine, Dept of Medical Social Sciences, 625 N. Michigan Ave, 21-00, Chicago, IL, 60611 USA
| | - Kristi Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 2115 Wisconsin Ave N, Ste. 300, Washington, DC 20007 USA
| | - Margaret Waltz
- University of North Carolina School of Medicine, Department of Social Medicine, 333 S Columbia St, Chapel Hill, NC 27516 USA
| | - David Farrell
- People Designs, Inc., 1304 Broad Street, Durham, NC 27705 USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Dept of Medical Social Sciences, 625 N. Michigan Ave, 21-00, Chicago, IL, 60611 USA,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 675 N St Clair St. Floor 21, Suite 100, Chicago, IL 60611 USA
| | - Anthony Chicaiza
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 2115 Wisconsin Ave N, Ste. 300, Washington, DC 20007 USA
| | - Rahma Omar
- Northwestern University Feinberg School of Medicine, Dept of Medical Social Sciences, 625 N. Michigan Ave, 21-00, Chicago, IL, 60611 USA
| | - Rebecca Thompson
- John Theurer Cancer Center at Hackensack University Medical Center, 92 2nd Street, Hackensack, NJ 07601 USA
| | - Mariska Kop
- Northwestern University Feinberg School of Medicine, Dept of Medical Social Sciences, 625 N. Michigan Ave, 21-00, Chicago, IL, 60611 USA,John Theurer Cancer Center at Hackensack University Medical Center, 92 2nd Street, Hackensack, NJ 07601 USA
| | - Alyssa N. Van Denburg
- Northwestern University Feinberg School of Medicine, Dept of Medical Social Sciences, 625 N. Michigan Ave, 21-00, Chicago, IL, 60611 USA
| | - Danielle Lorch
- Northwestern University Feinberg School of Medicine, Dept of Medical Social Sciences, 625 N. Michigan Ave, 21-00, Chicago, IL, 60611 USA
| | - Scott D. Rowley
- Georgetown University Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 2115 Wisconsin Ave N, Ste. 300, Washington, DC 20007 USA,John Theurer Cancer Center at Hackensack University Medical Center, 92 2nd Street, Hackensack, NJ 07601 USA
| | - Christine Rini
- Northwestern University Feinberg School of Medicine, Dept of Medical Social Sciences, 625 N. Michigan Ave, 21-00, Chicago, IL, 60611 USA,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 675 N St Clair St. Floor 21, Suite 100, Chicago, IL 60611 USA,Corresponding author
| |
Collapse
|
23
|
Oswald LB, Baik SH, Buscemi J, Buitrago D, Iacobelli F, Guitelman J, Penedo FJ, Yanez B. Effects of smartphone interventions on cancer knowledge and coping among Latina breast cancer survivors: Secondary analysis of a pilot randomized controlled trial. J Psychosoc Oncol 2021; 40:695-707. [PMID: 34620035 PMCID: PMC8986885 DOI: 10.1080/07347332.2021.1983688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: The My Guide smartphone application was developed to improve quality of life and symptom burden (primary outcomes) for Latina breast cancer survivors (BCS) and tested in a pilot randomized controlled trial compared to an attention-control condition (My Health smartphone application). This secondary analysis examined effects on breast cancer knowledge, coping, and cancer-related self-efficacy (intervention targets).Method: Latina BCS (N = 78) were randomized to My Guide or My Health for six weeks. Linear mixed-effects modeling evaluated the effects of time and study condition on the intervention targets. Effects by engagement were explored. Results: Both conditions showed improved breast cancer knowledge (p < 0.001), with a trend for greatest improvement among My Guide high users (p = 0.082). My Guide participants reported less self-blame overall than My Health participants (p = 0.020). There were no effects on cancer-related self-efficacy (ps > 0.05). Conclusion: Culturally-informed smartphone applications may enhance breast cancer knowledge and promote adaptive coping among Latina BCS.
Collapse
Affiliation(s)
- Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Sharon H. Baik
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francisco Iacobelli
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, USA
| | - Judith Guitelman
- ALAS-WINGS, Latina Association for Breast Cancer, Chicago, IL, USA
| | - Frank J. Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
24
|
Yeary KHK, Alcaraz KI, Ashing KT, Chiu C, Christy SM, Felsted KF, Lu Q, Lumpkins CY, Masters KS, Newton RL, Park CL, Shen MJ, Silfee VJ, Yanez B, Yi J. Considering religion and spirituality in precision medicine. Transl Behav Med 2021; 10:195-203. [PMID: 31294809 DOI: 10.1093/tbm/ibz105] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The emerging era of precision medicine (PM) holds great promise for patient care by considering individual, environmental, and lifestyle factors to optimize treatment. Context is centrally important to PM, yet, to date, little attention has been given to the unique context of religion and spirituality (R/S) and their applicability to PM. R/S can support and reinforce health beliefs and behaviors that affect health outcomes. The purpose of this article is to discuss how R/S can be considered in PM at multiple levels of context and recommend strategies for integrating R/S in PM. We conducted a descriptive, integrative literature review of R/S at the individual, institutional, and societal levels, with the aim of focusing on R/S factors with a high level of salience to PM. We discuss the utility of considering R/S in the suitability and uptake of PM prevention and treatment strategies by providing specific examples of how R/S influences health beliefs and practices at each level. We also propose future directions in research and practice to foster greater understanding and integration of R/S to enhance the acceptability and patient responsiveness of PM research approaches and clinical practices. Elucidating the context of R/S and its value to PM can advance efforts toward a more whole-person and patient-centered approach to improve individual and population health.
Collapse
Affiliation(s)
| | | | | | - Chungyi Chiu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | | | - Qian Lu
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Crystal Y Lumpkins
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | - Megan J Shen
- Weill Cornell Medical College, New York City, NY, USA
| | | | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jean Yi
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
25
|
Yanez B, Gray RJ, Sparano JA, Carlos RC, Sadigh G, Garcia SF, Gareen IF, Whelan TJ, Sledge GW, Cella D, Wagner LI. Association of Modifiable Risk Factors With Early Discontinuation of Adjuvant Endocrine Therapy: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Oncol 2021; 7:2780917. [PMID: 34137783 PMCID: PMC8377561 DOI: 10.1001/jamaoncol.2021.1693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/14/2021] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Early discontinuation of adjuvant endocrine therapy (ET) is problematic among breast cancer survivors, with previous studies suggesting that up to 50% of women do not adhere to the recommended full 5 years of ET treatment. OBJECTIVE To identify the association between early discontinuation of ET in the Trial Assigning Individualized Options for Treatment (TAILORx) and modifiable risk factors, polypharmacy, and types of additional medications such as antidepressants and opioids. DESIGN, SETTING, AND PARTICIPANTS This post hoc analysis includes a subgroup of 954 patients with breast cancer in TAILORx, a randomized clinical trial conducted from April 7, 2006, to October 6, 2010. All participants received a diagnosis of hormone receptor-positive, ERBB2-negative, axillary node-negative breast cancer and started ET within a year of study entry. Analyses were conducted in the intent-to-treat population. Statistical analysis took place from January 15, 2020, to April 6, 2021. MAIN OUTCOMES AND MEASURES Participants completed measures on cancer-related health-related quality of life including physical well-being and social well-being prior to initiating ET. Early discontinuation of ET was defined as discontinuation less than 4 years from initiation for reasons other than death or recurrence. Kaplan-Meier estimates were used to calculate discontinuation, and Cox proportional hazards regression joint prediction models were used to analyze the association between rates of adherence to ET with patient-level factors. RESULTS A total of 954 women (mean [SD] age, 56.6 [8.9] years) were included in this analysis. In a joint model, receipt of chemoendocrine therapy (vs receipt of ET only; hazard ratio [HR], 0.57; 95% CI, 0.35-0.92; P = .02) and age older than 40 years (vs ≤40 years; HR for 41-50 years, 0.39; 95% CI, 0.18-0.85; P = .02; HR for 51-60 years, 0.28; 95% CI, 0.13-0.60; P = .001; HR for 61-70 years, 0.40; 95% CI, 0.18-0.86; P = .02; and HR for >70 years, 0.23; 95% CI, 0.07-0.77; P = .02) were associated with a lower probability of early discontinuation of ET. Adjusted for these factors, a history of depression compared with no history of depression (HR, 1.82; 95% CI, 1.19-2.77; P = .005), worse physical well-being compared with better physical well-being (HR, 2.12; 95% CI, 1.30-3.45; P = .002), and worse social well-being compared with better social well-being (HR, 1.94; 95% CI, 1.20-3.13; P = .006) were individually and significantly associated with a higher probability of early discontinuation of ET. Only antidepressant use at study baseline was associated with early discontinuation (HR, 1.87; 95% CI, 1.23-2.84; P = .003). CONCLUSIONS AND RELEVANCE In this post hoc analysis of a randomized clinical trial, baseline patient-reported health-related quality of life components, such as poor social well-being, poor physical well-being, and comorbid depression, were significant risk factors for early discontinuation of endocrine therapies. These results support systematic screening for patient-reported outcomes and depressive symptoms to identify women at risk for discontinuation of ET. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00310180.
Collapse
Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert J. Gray
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network Biostatistics Center, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Joseph A. Sparano
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan Comprehensive Cancer Center, Ann Arbor
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sofia F. Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Timothy J. Whelan
- Canadian Cancer Trials Group, McMaster University, Hamilton, Ontario, Canada
| | - George W. Sledge
- Department of Medicine, Stanford Cancer Center Palo Alto, Stanford, California
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynne I. Wagner
- Department of Social Sciences and Health Policy, Wake Forest University Health Sciences, Winston Salem, North Carolina
| |
Collapse
|
26
|
Sadigh G, Gray RJ, Sparano JA, Yanez B, Garcia SF, Timsina LR, Sledge GW, Cella D, Wagner LI, Carlos RC. Breast cancer patients' insurance status and residence zip code correlate with early discontinuation of endocrine therapy: An analysis of the ECOG-ACRIN TAILORx trial. Cancer 2021; 127:2545-2552. [PMID: 33793979 DOI: 10.1002/cncr.33527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Early discontinuation is a substantial barrier to the delivery of endocrine therapies (ETs) and may influence recurrence and survival. The authors investigated the association between early discontinuation of ET and social determinants of health, including insurance coverage and the neighborhood deprivation index (NDI), which was measured on the basis of patients' zip codes, in breast cancer. METHODS In this retrospective analysis of a prospective randomized clinical trial (Trial Assigning Individualized Options for Treatment), women with hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer who started ET within a year of study entry were included. Early discontinuation was calculated as stopping ET within 4 years of its start for reasons other than distant recurrence or death via Kaplan-Meier estimates. A Cox proportional hazards joint model was used to analyze the association between early discontinuation of ET and factors such as the study-entry insurance and NDI, with adjustments made for other variables. RESULTS Of the included 9475 women (mean age, 55.6 years; White race, 84%), 58.0% had private insurance, whereas 11.7% had Medicare, 5.8% had Medicaid, 3.8% were self-pay, and 19.1% were treated at international sites. The early discontinuation rate was 12.3%. Compared with those with private insurance, patients with Medicaid (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.23-1.92) and self-pay patients (HR, 1.65; 95% CI, 1.25-2.17) had higher early discontinuation. Participants with a first-quartile NDI (highest deprivation) had a higher probability of discontinuation than those with a fourth-quartile NDI (lowest deprivation; HR, 1.34; 95% CI, 1.11-1.62). CONCLUSIONS Patients' insurance and zip code at study entry play roles in adherence to ET, with uninsured and underinsured patients having a high rate of treatment nonadherence. Early identification of patients at risk may improve adherence to therapy. LAY SUMMARY In this retrospective analysis of 9475 women with breast cancer participating in a clinical trial (Trial Assigning Individualized Options for Treatment), Medicaid and self-pay patients (compared with those with private insurance) and those in the highest quartile of neighborhood deprivation scores (compared with those in the lowest quartile) had a higher probability of early discontinuation of endocrine therapy. These social determinants of health assume larger importance with the expected increase in unemployment rates and loss of insurance coverage in the aftermath of the coronavirus disease 2019 pandemic. Early identification of patients at risk and enrollment in insurance optimization programs may improve the persistence of therapy.
Collapse
Affiliation(s)
| | - Robert J Gray
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Lava R Timsina
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| |
Collapse
|
27
|
Salsman JM, Yanez B, Snyder MA, Avina AR, Clayman ML, Smith KN, Purnell K, Victorson D. Attitudes and practices about fertility preservation discussions among young adults with cancer treated at a comprehensive cancer center: patient and oncologist perspectives. Support Care Cancer 2021; 29:5945-5955. [PMID: 33763727 DOI: 10.1007/s00520-021-06158-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young adults (YAs, ages 18-39) diagnosed with cancer face multiple challenges that affect their health-related quality of life, including the potential for cancer-related infertility. Providing information about the risk of infertility and options to maintain fertility is critical for YAs who are newly diagnosed. However, barriers to effective communication exist for oncologists and their patients. The purpose of this study was to interview medical oncologists and YAs from the same cancer center to examine attitudes and practices about fertility preservation. METHODS Semi-structured interviews were conducted with medical oncologists (N=12) and YAs within 2 years post-treatment (N=24), representing the most common cancers affecting YAs. Interviews were audio-recorded, transcribed, and coded using qualitative methodologies with the analysis software NVivo 10. RESULTS Twelve oncologists (50% female, 67% <50 years) and 24 YAs (67% female, M=29 years) completed interviews. Common themes across oncologist and YA interviews were the roles of cancer type or stage and patient interest or parity in influencing the decision. The most important factor for YAs was to receive accurate, in-depth information. Unique themes for oncologists focused on clinical aspects of their patient's disease. For YAs, they shared about the emotional impact of cancer-related infertility and desire for support from trusted others. CONCLUSIONS Results provide a better understanding of the attitudes and practices about fertility preservation discussions among YAs. Given the common factors affecting fertility preservation decisions, models of shared decision-making may be ideal for YAs and oncologists. Future interventions should explore tailored applications of this approach for YAs newly diagnosed with cancer.
Collapse
Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine & the Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Mallory A Snyder
- Office of Research and National Laboratories, The University of Chicago, Chicago, IL, USA
| | - Alexis R Avina
- San Diego County Health and Human Services Agency, San Diego, CA, USA
| | - Marla L Clayman
- General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristin N Smith
- The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
- Center for Fertility and Reproductive Medicine, Northwestern Medicine, Chicago, IL, USA
| | | | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| |
Collapse
|
28
|
Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021; 26:443-452. [PMID: 33594785 DOI: 10.1002/onco.13729] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
Collapse
Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| |
Collapse
|
29
|
Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021. [PMID: 33594785 DOI: 10.1002/onco.13729.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
Collapse
Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| |
Collapse
|
30
|
Baik SH, Oswald LB, Buscemi J, Buitrago D, Iacobelli F, Perez-Tamayo A, Guitelman J, Penedo FJ, Yanez B. Patterns of Use of Smartphone-Based Interventions Among Latina Breast Cancer Survivors: Secondary Analysis of a Pilot Randomized Controlled Trial. JMIR Cancer 2020; 6:e17538. [PMID: 33289669 PMCID: PMC7755528 DOI: 10.2196/17538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/10/2020] [Accepted: 11/11/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Latina breast cancer survivors experience poorer health-related quality of life (HRQoL), greater symptom burden, and more psychosocial needs compared to non-Latina breast cancer survivors. eHealth platforms such as smartphone apps are increasingly being used to deliver psychosocial interventions to cancer survivors. However, few psychosocial eHealth interventions have been developed specifically for Latina breast cancer survivors. Further, little is known about how Latinas, in general, engage with eHealth interventions and whether specific participant characteristics are associated with app use in this population. We evaluated the use of 2 culturally informed, evidence-based smartphone apps for Latina breast cancer survivors-one that was designed to improve HRQoL and reduce symptom burden (My Guide) and the other to promote healthy lifestyle behaviors (My Health). OBJECTIVE The objectives of our study were to explore the patterns of use of the My Guide intervention app and My Health attention-control app among Latina breast cancer survivors. METHODS Eighty Latina breast cancer survivors were randomized to use the My Guide or My Health app for 6 weeks. Assessments were collected at baseline (T1), immediately after the 6-week intervention (T2), and 2 weeks after T2 (T3). Specific study outcomes included subdomains of HRQoL, symptom burden, cancer-specific distress, cancer-relevant self-efficacy, and breast cancer knowledge. RESULTS On average, participants used their assigned app for more than 1 hour per week. Sociodemographic or psychological characteristics were not significantly associated with app use, except for employment status in the My Health group. Content related to common physical and emotional symptoms of breast cancer survivors as well as recommendations for nutrition and physical activity were most frequently accessed by My Guide and My Health participants, respectively. Lastly, clinically meaningful improvements were demonstrated in breast cancer well-being among low app users (ie, <60 minutes of use/week) of My Guide and social well-being among high app users (ie, ≥60 minutes of use/week) of My Health. CONCLUSIONS The favorable rates of participant use across both apps suggest that Latina breast cancer survivors are interested in the content delivered across both My Guide and My Health. Furthermore, since sociodemographic variables, excluding employment status, and baseline HRQoL (psychological variable) were not related to app use, My Guide and My Health may be accessible to diverse Latina breast cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov NCT03645005; https://clinicaltrials.gov/ct2/show/NCT03645005.
Collapse
Affiliation(s)
- Sharon H Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, United States
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, United States
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Francisco Iacobelli
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, United States
| | | | - Judith Guitelman
- ALAS-WINGS, The Latina Association for Breast Cancer, Chicago, IL, United States
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
31
|
Penedo FJ, Fox RS, Oswald LB, Moreno PI, Boland CL, Estabrook R, McGinty HL, Mohr DC, Begale MJ, Dahn JR, Flury SC, Perry KT, Kundu SD, Yanez B. Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial. Int J Behav Med 2020; 27:490-505. [PMID: 31898309 DOI: 10.1007/s12529-019-09839-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Men with advanced prostate cancer (APC) face multiple challenges including poor prognosis, poor health-related quality of life (HRQOL), and elevated symptom burden. This study sought to establish the efficacy of a tablet-delivered, group-based psychosocial intervention for improving HRQOL and reducing symptom burden in men with APC. We hypothesized that men randomized to cognitive-behavioral stress management (CBSM) would report improved HRQOL and reduced symptom burden relative to men randomized to an active control health promotion (HP) condition. Condition effects on intervention targets and moderators of these effects were explored. METHODS Men with APC (N = 192) were randomized (1:1) to 10-week tablet-delivered CBSM or HP, and followed for 1 year. Multilevel modeling was used to evaluate condition effects over time. RESULTS Changes in HRQOL and symptom burden did not differ between groups. Men in both groups improved across several intervention targets; men in the CBSM condition reported greater increases in self-reported ability to relax, and both conditions showed improvements in cancer-related anxiety, cancer-related distress, and feelings of cohesiveness with other patients over time. Moderating factors included baseline interpersonal disruption, fatigue, and sexual functioning. CONCLUSIONS Tablet-delivered CBSM and HP were well received by men with APC. The hypothesized effects of CBSM on HRQOL and symptom burden were not supported, though improvements in intervention targets were observed across conditions. Participants reported high-baseline HRQOL relative to cancer and general population norms, possibly limiting intervention effects. The identified moderating factors should be considered in the development and implementation of interventions targeting HRQOL and symptom burden. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03149185.
Collapse
Affiliation(s)
- Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5th Floor, Coral Gables, FL, 33146, USA.
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patricia I Moreno
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cody L Boland
- Departments of Psychology and Medicine, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, 5th Floor, Coral Gables, FL, 33146, USA
| | - Ryne Estabrook
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Heather L McGinty
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David C Mohr
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jason R Dahn
- Mental Health and Behavioral Sciences Service, Miami Veterans Affairs Healthcare System, Miami, FL, USA
| | - Sarah C Flury
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kent T Perry
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shilajit D Kundu
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
32
|
Smith JD, Garcia SF, Penedo FJ, Scholtens DM, Yanez B, Kircher SM, Cella D. An effectiveness-implementation hybrid trial for informatics-based cancer symptom management. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
236 Background: Oncology outpatients can facesignificant cancer- and treatment-related symptoms that compromise health related quality of life and quality health care. Although the burden of symptoms on patients’ lives are well-known, most health care systems are not ideally set up to relieve them. Patients are not typically drawn into meaningful engagement with the health care team in ways that enable symptom self-management. As a result, opportunities for early identification and treatment are lost, causing avoidable human suffering and cost. The Northwestern University IMPACT (NU IMPACT) project aims to evaluate the effectiveness and implementation of an informatics-driven symptom monitoring and web-based self-management intervention. The project uses PROMIS measures, integrated into the EHR, to trigger response and intervention. This presentation describes the effectiveness-implementation hybrid trial design and measurement of implementation. Methods: NU IMPACT will test the effectiveness and implementation of a system-wide symptom management intervention, across six adult hematology/oncology and gynecologic oncology outpatient clinics at Northwestern Memorial HealthCare, using a cluster randomized pragmatic roll-out implementation trial with an embedded individual-level randomized clinical trial. This unique design allows for a fully-powered randomized trial to establish the efficacy of the intervention, as well as a randomized test of implementation. We are enrolling approximately 6,000 patients in pre-implementation and 6,000 in post-implementation, with half of the latter group randomly assigned to enhanced symptom management, and the other half to usual care. Results: Implementation process is guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) model with evaluation following the RE-AIM framework. Particular focus is paid to adoption at the clinic and provider levels, the extent to which the intervention achieves meaningful reach to cancer patients, and the potential for sustainment. Additionally, we are testing and validating a newly developed method for tracking and reporting dynamic changes to implementation strategies. Conclusions: Achieving the aims of the NU IMPACT project is a critical step in the advancement of informatics-driven symptom management interventions for cancer patients. The innovative implementation trial design and measurement approach will aid in the rapid translation of findings to other healthcare systems. Clinical trial information: NCT03988543 .
Collapse
Affiliation(s)
- Justin D. Smith
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sofia F. Garcia
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| |
Collapse
|
33
|
Buscemi J, Oswald LB, Baik SH, Buitrago D, Iacobelli F, Phillips SM, Perez-Tamayo A, Guitelman J, Penedo FJ, Yanez B. My health smartphone intervention decreases daily fat sources among Latina breast cancer survivors. J Behav Med 2020; 43:732-742. [PMID: 31970652 PMCID: PMC7374026 DOI: 10.1007/s10865-020-00136-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/17/2020] [Indexed: 12/15/2022]
Abstract
Breast cancer is the most common cancer among Latina women, and Latina women are at higher risk for breast cancer mortality than white women. Lifestyle factors, such as consuming a nutritious diet and engaging in regular physical activity, promote health and are protective against heart disease, type 2 diabetes, and breast cancer recurrence. Previous studies have developed and tested interventions for Latina breast cancer survivors to improve diet and increase physical activity, however, no studies to date have developed a smartphone delivered intervention. The purpose of the current study was to compare two Smartphone delivered interventions, My Health, which focused on diet and physical activity, and My Guide, which focused on psychosocial functioning, on dietary and physical activity outcomes, post-intervention, and at a 2-week follow-up assessment. Overall, participants receiving the My Health intervention reported a greater reduction in daily fat sources than the My Guide group over time. However, daily sources of fat did not differ between conditions. Walking, measured by estimated weekly metabolic equivalents, increased across time points in both groups. These preliminary findings suggest that eHealth interventions aimed at improving lifestyle factors may favorably impact nutritional intake and physical activity. Future research should utilize more comprehensive and objective measures of diet and physical activity, and incorporate more behavioral lifestyle components into the intervention in larger samples with a longer follow-up period.
Collapse
Affiliation(s)
- Joanna Buscemi
- Department of Psychology, DePaul University, 2219 N Kenmore Ave, Chicago, IL, 60614, USA.
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Sharon H Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Francisco Iacobelli
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Judy Guitelman
- ALAS-WINGS, Latina Association for Breast Cancer, Chicago, IL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
34
|
Lattie EG, Bass M, Garcia SF, Phillips SM, Moreno PI, Flores AM, Smith JD, Scholtens D, Barnard C, Penedo FJ, Cella D, Yanez B. Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation. JMIR Form Res 2020; 4:e18412. [PMID: 32955450 PMCID: PMC7536600 DOI: 10.2196/18412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 01/22/2023] Open
Abstract
Background Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management. Objective This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system. Methods A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability. Results Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements. Conclusions Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform.
Collapse
Affiliation(s)
- Emily G Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Michael Bass
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Patricia I Moreno
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - J D Smith
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States.,Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia Barnard
- Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States.,Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| |
Collapse
|
35
|
Oswald LB, Guitelman J, Buitrago D, Buscemi J, Iacobelli F, Perez-Tamayo A, Penedo F, Yanez B. Community Perspectives: Developing and Implementing a Smartphone Intervention for Latina Breast Cancer Survivors in Chicago. Prog Community Health Partnersh 2020; 13:131-136. [PMID: 31378743 DOI: 10.1353/cpr.2019.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Compared with non-Latina White breast cancer survivors (BCS), Latina BCS have poorer health-related quality of life and greater psychosocial needs. However, Latinas are less engaged in clinical research owing to barriers including less access to health-related information, less awareness of clinical trials, and practical barriers (e.g., competing time demands). Latina BCS are in need of educational and health-related resources that are culturally informed, scalable, and accessible. In 2015, the Chicago Cancer Health Equity Collaborative (ChicagoCHEC), a National Cancer Institute research collaborative, and ALAS-WINGS, a community organization providing educational and supportive resources to Latina BCS, partnered to develop My Guide. My Guide is a smartphone application-based intervention for Latina BCS designed to improve health-related quality of life (HRQOL). This article summarizes the experiences of ChicagoCHEC and ALAS-WINGS throughout the community-engaged research (CEnR) partnership. Using existing relationships in community and academic settings via CEnR provides an ideal starting point for tailoring resources to Latina BCS and engaging Latina BCS in health-related research.
Collapse
|
36
|
Behrman P, Fitzgibbon M, Buscemi J, Sanchez-Johnsen L, Laroche H, Yanez B, Gonzales R, Gwede CK, Raja S, Jacobson L, Gil-Rivas V, Tam-Ashing K. Society of Behavioral Medicine Position Statement: Congress should protect immigrants seeking health care. Transl Behav Med 2020; 9:1244-1247. [PMID: 31367753 DOI: 10.1093/tbm/ibz119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
According to the Migration Policy Institute (2019), as of 2017 the USA was home to approximately 44 million immigrants, the largest number of immigrants in the world. Most of these immigrants relocate from Mexico, India, China, the Philippines, El Salvador, Vietnam, Cuba, and the Dominican Republic. Since 2017, there have been increased reports of Immigrations and Customs Enforcement (ICE) interventions toward immigrants, especially at and near previously delineated "safe areas" such as medical facilities, as immigrants sought health care. Currently, health care providers are reporting delays and reductions in health care seeking by immigrants. This increases risks of untreated health problems for the immigrants themselves as well as their communities. To protect the health of immigrants, and the general public, the Society of Behavioral Medicine joins the American College of Physicians (2011) and the American Medical Association (2017) in recommending that Congress impose restrictions on ICE interventions in or around medical facilities.
Collapse
Affiliation(s)
- Pamela Behrman
- Department of Psychology, College of Mount Saint Vincent, Bronx, NY, USA
| | | | | | | | - Helena Laroche
- Carver School of Medicine, University of Iowa Health Care, Iowa City, IA, USA
| | - Betina Yanez
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rubi Gonzales
- Doctoral Program in Health Psychology, University of Texas at El Paso, El Paso, TX, USA
| | | | - Sheela Raja
- University of Illinois at Chicago, Chicago, IL, USA
| | - Lisette Jacobson
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | | | | |
Collapse
|
37
|
Baik SH, Oswald LB, Buitrago D, Buscemi J, Iacobelli F, Perez-Tamayo A, Guitelman J, Diaz A, Penedo FJ, Yanez B. Cancer-Relevant Self-Efficacy Is Related to Better Health-Related Quality of Life and Lower Cancer-Specific Distress and Symptom Burden Among Latina Breast Cancer Survivors. Int J Behav Med 2020; 27:357-365. [PMID: 32394220 PMCID: PMC7518020 DOI: 10.1007/s12529-020-09890-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Latina breast cancer survivors (BCS) often report poorer health-related quality of life (HRQOL), higher symptom burden, and greater psychosocial needs compared to non-Latina BCS. However, Latinas are underrepresented in cancer survivorship research and more work is needed to examine the factors contributing to these psychosocial disparities. This study aimed to evaluate potentially modifiable patient characteristics associated with HRQOL, breast cancer concerns, and cancer-specific distress among Latina BCS. METHODS Baseline data was evaluated in 95 Latina BCS who participated in a smartphone-based psychosocial intervention designed to improve HRQOL. Hierarchical linear regression analyses were conducted to evaluate the associations between modifiable factors that have been shown to favorably impact outcomes in cancer populations (i.e., cancer-relevant self-efficacy, breast cancer knowledge) with overall and domain-specific HRQOL, breast cancer symptom burden, and cancer-specific distress, after controlling for sociodemographic and cancer-related characteristics. RESULTS Greater cancer-relevant self-efficacy was related to better overall HRQOL as well as better social, emotional, and functional well-being domains. Greater cancer-relevant self-efficacy was also related to less breast cancer symptom burden and less cancer-specific distress. Breast cancer knowledge was not associated with any of the study outcomes. CONCLUSIONS Results demonstrate that cancer-relevant self-efficacy is a significant correlate of general and domain-specific HRQOL, breast cancer symptom burden, and cancer-specific distress among Latina BCS. Future interventions in this population should target cancer-relevant self-efficacy as a possible mechanism to improve HRQOL outcomes and survivorship experiences for Latina BCS.
Collapse
Affiliation(s)
- Sharon H Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL, USA
| | - Francisco Iacobelli
- Department of Computer Science, Northeastern Illinois University, Chicago, IL, USA
| | | | - Judy Guitelman
- ALAS-WINGS, The Latina Association for Breast Cancer, Chicago, IL, USA
| | - Alma Diaz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
38
|
Bouchard LC, Yanez B, Dahn JR, Flury SC, Perry KT, Mohr DC, Penedo FJ. Brief report of a tablet-delivered psychosocial intervention for men with advanced prostate cancer: Acceptability and efficacy by race. Transl Behav Med 2020; 9:629-637. [PMID: 30285186 DOI: 10.1093/tbm/iby089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Relative to non-Hispanic whites (NHW), black men are disproportionately affected by prostate cancer (PC) incidence, have poorer PC outcomes, and report greater compromises in health-related quality of life. Despite these challenges, black men are underrepresented in psychosocial cancer research, possibly due to limited access to supportive oncology programs. The purpose of this article is to examine the acceptability and efficacy for reducing disease-specific distress of a tablet-delivered psychosocial intervention for older men with advanced PC (APC) and explore differences by race. Men with APC (N = 192, 37.5% black, age M = 68.84 years) were randomized to 10-week Cognitive Behavioral Stress Management (CBSM) or attention-control Health Promotion (HP), both delivered via tablets. Assessments occurred at baseline in person, weekly during the 10-week program via tablets, and at 6 and 12 months in person. Weekly session evaluations and postprogram exit surveys assessed acceptability. Efficacy was assessed with a measure of PC-anxiety validated with racially diverse PC patients using linear mixed effects modeling. Study retention and group attendance did not differ by race. CBSM and HP were both acceptable among older APC patients. Black men rated both conditions more favorably than NHW men. Men in CBSM (vs. HP) reported greater reductions in PC-anxiety at 6 months (not sustained at 12 months). Black men in CBSM reported greater decreases in PC-anxiety over time compared with all other groups. Tablet-delivered CBSM and HP were acceptable for black and NHW APC patients, although black men rated both conditions more favorably. Black men reported a unique intervention benefit related to reduced disease-specific distress.
Collapse
Affiliation(s)
- Laura C Bouchard
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jason R Dahn
- Mental Health and Behavioral Sciences Service, Miami Veterans Affairs Healthcare System, Miami, FL, USA
| | - Sarah C Flury
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kent T Perry
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David C Mohr
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank J Penedo
- Departments of Psychology and Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| |
Collapse
|
39
|
Sadigh G, Gray RJ, Yanez B, Wagner LI, Garcia SF, Sparano JA, Cella D, Carlos R. Breast cancer patients’ insurance status correlates with their adherence to endocrine therapy: Analysis of ECOG-ACRIN TAILORx trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7041 Background: Cancer patients spend substantial amounts on their healthcare services, and are at high risk for financial toxicity, a patient-reported outcome shown to be associated with care non-adherence. Even with insurance, cancer patients often face unpredictable or unmanageable costs. In women with breast cancer enrolled in TAILORx trial, we investigated the association between study entry insurance status and adherence to endocrine therapy (ET). Methods: Women with hormone-receptor–positive, human epidermal growth factor receptor 2–negative, axillary node–negative breast cancer enrolled in TAILORx clinical trial who started ET within a year of study entry were included. Early discontinuation was defined as stopping ET within 4 years of start for reasons other than distant recurrence or death, and the rate was calculated using Kaplan-Meier estimates. Cox proportional hazards model was used to analyze association between the patients’ insurance status at study entry and early discontinuation of ET incorporating patients’ treatment, age, race and Recurrence Score in the model. Results: A total of 9,475 patients were included (mean age: 55.6; 84% white; 9% Hispanic). A total of 58.0% had private insurance, while 11.7% had Medicare; 5.8% had Medicaid; 0.98% had military/VA insurance; 3.8% were self-pay, and 19.1% were patient recruited from international sites. The rates of 4-year early discontinuation were highest among self-pay (18.7%) and Medicaid patients (18%) and lowest among patients with military/VA insurance (8.6%) and international sites (9.8%). In multivariable analysis, compared to private insurance patients with Medicaid (HR 1.6; 95% CI 1.3-2.0) and self-pay (HR 1.6; 95% CI 1.3-2.1) had higher probability of discontinuing ET within 4 years of start and those at international sites had lower probability of early discontinuation (HR 0.8; 95% CI 0.7-0.9) (All p values < 0.05). Conclusions: Patients’ insurance status plays an important role in adherence to ET with uninsured and underinsured having a high rate of treatment non-adherence. Early identification of patients at risk and enrollment in insurance optimization programs may improve adherence to therapy. Clinical trial information: NCT00310180 .
Collapse
Affiliation(s)
| | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Sofia F. Garcia
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | | | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| |
Collapse
|
40
|
Yanez B, Gray RJ, Sparano JA, Carlos R, Sadigh G, Garcia SF, Gareen IF, Whelan TJ, Sledge GW, Cella D, Wagner LI. Early discontinuation to adjuvant endocrine therapy in the ECOG-ACRIN TAILORx Trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7004 Background: The TAILORx study demonstrated women with an intermediate Oncotype DX score receive the same benefit with endocrine therapy (ET) compared to chemoendocrine therapy (CET). However, early discontinuation of adjuvant ET is problematic among breast cancer survivors, with previous studies suggesting that up to 50% of women do not adhere to the full 5 years of recommended ET treatment. The aim of this study was to identify patient-level risk factors associated with early discontinuation of ET in the TAILORx study. Methods: TAILORx was coordinated by the ECOG-ACRIN Cancer Research Group. Participants were a subgroup of 954 women who completed additional measures on health-related quality of life (HRQoL) including endocrine symptoms (ES) physical well-being (PWB) and social well-being (SWB) prior to initiating ET, which categorized into three groups by tertile for analysis. All participants were diagnosed with hormone-receptor–positive, human epidermal growth factor receptor 2–negative, axillary node–negative breast cancer who started ET within a year of study entry. Early discontinuation of ET, defined as discontinuation less than 4 years from initiation for reasons other than death or recurrence, was assessed by clinician report. Rate of discontinuation was calculated using Kaplan-Meier estimates, and Cox-proportional hazards joint models were used to analyze the association between rates of adherence to ET with patient-level factors. Results: In a joint model, receipt of CET therapy (vs receipt of ET only; HR = .59, 95% CI .38-.94, p = .02) and age above 40 (versus age < = 40; HR = .30, 95% CI .14-.66, p = .003) were associated with a lower probability of early discontinuation of ET. Adjusted for these factors, a history of depression compared to no history of depression (HR 1.82, 95% CI 1.19-2.77, p = 0.005), worse ES compared to better ES (HR 1.70, 95% CI 1.06-2.74, p = 0.03), worse PWB compared to better PWB (HR 2.12, 95% CI 1.30-3.45,p = 0.003), and worse SWB compared to better SWB (HR 1.94, 95% CI 1.20-3.13, p = 0.007) were individually and significantly associated with a higher probability of early discontinuation of ET, although none reached statistical significance when all were included in a joint model. Conclusions: Younger women are at risk for early discontinuation and modifiable characteristics such as HRQoL and history of depression are potential risk factors for early discontinuation of ET. These results support systematic screening for HRQoL and depressive symptoms to identify women at risk for discontinuation of ET. Clinical trial information: NCT00310180 .
Collapse
Affiliation(s)
- Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Sofia F. Garcia
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ilana F Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | | | | | | | | |
Collapse
|
41
|
Penedo FJ, Oswald LB, Kronenfeld JP, Garcia SF, Cella D, Yanez B. The increasing value of eHealth in the delivery of patient-centred cancer care. Lancet Oncol 2020; 21:e240-e251. [PMID: 32359500 PMCID: PMC7643123 DOI: 10.1016/s1470-2045(20)30021-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 12/23/2022]
Abstract
The increasing use of eHealth has ushered in a new era of patient-centred cancer care that moves beyond the traditional in-person care model to real-time, dynamic, and technology-assisted assessments and interventions. eHealth has the potential to better the delivery of cancer care through improved patient-provider communication, enhanced symptom and toxicity assessment and management, and optimised patient engagement across the cancer care continuum. In this Review, we provide a brief, narrative appraisal of the peer reviewed literature over the past 10 years related to the uses of patient-centred eHealth to improve cancer care delivery. These uses include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. In addition, we discuss the challenges of, and opportunities for, accessibility, scalability, and implementation of these technologies, important areas for further development, and future research directions.
Collapse
Affiliation(s)
- Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Laura B Oswald
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| |
Collapse
|
42
|
Wagner LI, Gray RJ, Sparano JA, Whelan TJ, Garcia SF, Yanez B, Tevaarwerk AJ, Carlos RC, Albain KS, Olson JA, Goetz MP, Pritchard KI, Hayes DF, Geyer CE, Dees EC, McCaskill-Stevens WJ, Minasian LM, Sledge GW, Cella D. Patient-Reported Cognitive Impairment Among Women With Early Breast Cancer Randomly Assigned to Endocrine Therapy Alone Versus Chemoendocrine Therapy: Results From TAILORx. J Clin Oncol 2020; 38:1875-1886. [PMID: 32271671 DOI: 10.1200/jco.19.01866] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) is common during adjuvant chemotherapy and may persist. TAILORx provided a novel opportunity to prospectively assess patient-reported cognitive impairment among women with early breast cancer who were randomly assigned to chemoendocrine therapy (CT+E) versus endocrine therapy alone (E), allowing us to quantify the unique contribution of chemotherapy to CRCI. METHODS Women with a 21-gene recurrence score of 11 to 25 enrolled in TAILORX were randomly assigned to CT+E or E. Cognitive impairment was assessed among a subgroup of 552 evaluable women using the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) questionnaire, administered at baseline, 3, 6, 12, 24, and 36 months. The FACT-Cog included the 20-item Perceived Cognitive Impairment (PCI) scale, our primary end point. Clinically meaningful changes were defined a priori and linear regression was used to model PCI scores on baseline PCI, treatment, and other factors. RESULTS FACT-Cog PCI scores were significantly lower, indicating more impairment, at 3, 6, 12, 24, and 36 months compared with baseline for both groups. The magnitude of PCI change scores was greater for CT+E than E at 3 months, the prespecified primary trial end point, and at 6 months, but not at 12, 24, and 36 months. Tests of an interaction between menopausal status and treatment were nonsignificant. CONCLUSION Adjuvant CT+E is associated with significantly greater CRCI compared with E at 3 and 6 months. These differences abated over time, with no significant differences observed at 12 months and beyond. These findings indicate that chemotherapy produces early, but not sustained, cognitive impairment relative to E, providing reassurance to patients and clinicians in whom adjuvant chemotherapy is indicated to reduce recurrence risk.
Collapse
Affiliation(s)
| | - Robert J Gray
- ECOG-ACRIN Cancer Research Group Biostatistics Center, Boston, MA
| | - Joseph A Sparano
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Timothy J Whelan
- McMaster University, Canadian Cancer Trials Group, Hamilton, Ontario, Canada
| | | | - Betina Yanez
- Northwestern University School of Medicine, Chicago, IL
| | | | - Ruth C Carlos
- The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - John A Olson
- University of Maryland School of Medicine, Baltimore, MD
| | | | - Kathleen I Pritchard
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Daniel F Hayes
- The University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Charles E Geyer
- Virginia Commonwealth University Massey Cancer Center Minority/Underserved National Cancer Institute Community Oncology Research Program, Richmond, VA
| | | | | | | | | | - David Cella
- Northwestern University School of Medicine, Chicago, IL
| |
Collapse
|
43
|
Yanez B, Oswald LB, Baik SH, Buitrago D, Iacobelli F, Perez-Tamayo A, Guitelman J, Penedo FJ, Buscemi J. Brief culturally informed smartphone interventions decrease breast cancer symptom burden among Latina breast cancer survivors. Psychooncology 2020; 29:195-203. [PMID: 31693265 PMCID: PMC7008945 DOI: 10.1002/pon.5281] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Latina breast cancer survivors (BCS) report more symptom burden and poorer health-related quality of life than non-Latina BCS. However, there are few evidence-based and culturally informed resources that are easily accessible to this population. This study aimed to establish the feasibility and preliminary efficacy of the My Guide and My Health smartphone applications among Latina BCS. Both applications are culturally informed and contain evidence-based information for reducing symptom burden and improving health-related quality of life (My Guide) or healthy lifestyle promotion (My Health). METHODS Participants (N = 80) were randomized to use the My Guide or My Health smartphone applications for 6 weeks. Assessments occurred at baseline (T1) after the 6-week intervention (T2) and 2-week post-T2 (T3). Outcomes were participant recruitment and retention rates, patient-reported satisfaction, and validated measures of symptom burden and health-related quality of life. RESULTS Recruitment was acceptable (79%), retention was excellent (>90%), and over 90% of participants were satisfied with their application. On average, participants in both conditions used the applications for more than 1 hour per week. Symptom burden declined from T1 to T2 across both conditions, but this decline was not maintained at T3. Breast cancer well-being improved from T1 to T2 across both conditions and was maintained at T3. CONCLUSIONS Latina BCS who used the My Guide and My Health applications reported temporary decreases in symptom burden and improved breast cancer well-being over time, though there were no differential effects between conditions. Findings suggest that technology may facilitate Latina BCS engagement in care after breast cancer treatment.
Collapse
Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura B. Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida
| | - Sharon H. Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diana Buitrago
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Francisco Iacobelli
- Department of Computer Science, Northeastern Illinois University, Chicago, Illinois
| | | | - Judy Guitelman
- Latina Association for Breast Cancer, ALAS-WINGS, Chicago, Illinois
| | - Frank J. Penedo
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, Illinois
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
44
|
Peipert JD, Badawy SM, Baik SH, Oswald LB, Efficace F, Garcia SF, Mroczek DK, Wolf M, Kaiser K, Yanez B, Cella D. Development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Medication Adherence Scale (PMAS). Patient Prefer Adherence 2020; 14:971-983. [PMID: 32606615 PMCID: PMC7293395 DOI: 10.2147/ppa.s249079] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Poor medication adherence is associated with reduced drug effectiveness, poor health-related quality of life, increased morbidity and mortality, and increased healthcare utilization and cost. Including the patient's voice is essential in understanding barriers to adherence. Useful patient-reported adherence measures are brief, inexpensive, non-invasive; can indicate barriers to adherence; and can be incorporated in electronic health records. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) includes high-quality, freely available patient-reported measures covering many important constructs in patient-centered research but does not include a medication adherence measure. To fill this gap, we developed the PROMIS Medication Adherence Scale (PMAS) using the rigorous PROMIS instrument development guidelines. To develop the PMAS, we first conducted a review of the reviews, which enabled us to identify content areas relevant to medication adherence behavior. Then, we conducted qualitative research to elicit patients' views of and experiences with medication adherence. This process identified the following important content areas to guide item writing: extent medication is taken, knowledge of medication regimen, beliefs about medication, remembering to take medication, skipping due to side effects, skipping due to feeling better, and cost of medications. Based on the results of these activities, we wrote items and aimed to retain 1-2 items per content area. The final item set included 9 total adherence items, which were then refined through intensive comprehension and translatability review, as well as cognitive interviews. Future steps include testing the PMAS's validity.
Collapse
Affiliation(s)
- John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Correspondence: John Devin Peipert Email
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Sharon H Baik
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laura B Oswald
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fabio Efficace
- Italian Group for Adult Hematologic Disease (GIMEMA), Health Outcomes Research Unit, Rome, Italy
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Wolf
- Department of Medicine, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
45
|
Yanez B, Baik SH, Oswald LB, Buitrago D, Buscemi J, Iacobelli F, Perez-Tamayo A, Fajardo P, Serrano G, Guitelman J, Penedo FJ. An Electronic Health Intervention for Latina Women Undergoing Breast Cancer Treatment (My Guide for Breast Cancer Treatment): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14339. [PMID: 31833834 PMCID: PMC6935046 DOI: 10.2196/14339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Among Latinas and Hispanics (henceforth referred to as Latinas), breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related deaths. However, few interventions have been developed to meet the needs of Latina women undergoing active treatment for breast cancer. OBJECTIVE This paper aims to describe the procedures and methods of My Guide for Breast Cancer Treatment and the plans for conducting a multisite randomized controlled trial to investigate the feasibility and preliminary efficacy of this smartphone-based app for Latina women in active treatment for breast cancer. METHODS Study participants will be randomized to the My Guide for Breast Cancer Treatment intervention or the enhanced usual care control condition for 12 weeks. Participants will have access to innovative features such as gamification via virtual awards to reinforce usage and an adaptive section that presents targeted material based on their self-reported concerns and needs. Using a stepped-care approach, intervention participants will also receive telecoaching to enhance their adherence to the app. Study outcomes and intervention targets will be measured at study enrollment (before randomization), 6 and 12 weeks after initial app use. General and disease-specific health-related quality of life (HRQoL) and symptom burden are the study's primary outcomes, whereas anxiety, depression, fear of cancer recurrence, physical activity, and dietary intake are secondary outcomes. RESULTS Recruitment began in August 2019 and is expected to be completed by August 2020. We expect to submit study results for publication by fall 2020. CONCLUSIONS My Guide for Breast Cancer Treatment has the potential to improve HRQoL and reduce symptom burden, and increase access to supportive care resources among Latina breast cancer patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/14339.
Collapse
Affiliation(s)
- Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sharon H Baik
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Laura B Oswald
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Diana Buitrago
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | | | | | - Precilla Fajardo
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Gabriela Serrano
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | | |
Collapse
|
46
|
Stump TK, Robinson JK, Yanez B, Penedo F, Ezeofor A, Kircher S, Spring B. Physicians' perspectives on medication adherence and health promotion among cancer survivors. Cancer 2019; 125:4319-4328. [PMID: 31448414 DOI: 10.1002/cncr.32410] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/25/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cancer survivors face an increased risk of cardiovascular events compared with the general population. Adopting a healthy lifestyle may reduce these risks, and guidelines encourage health-promotion counseling for cancer survivors, but the extent of physician adherence is unclear. METHODS This mixed-method study surveyed 91 physicians, including 30 primary care physicians (PCPs), 30 oncologists, and 31 specialists (urologists, dermatologists, and gynecologists). Interviews also were conducted with 12 oncologists. RESULTS Most PCPs (90%) reported recommending health promotion (eg, weight loss, smoking cessation) to at least some cancer survivors, whereas few oncologists (26.7%) and specialists (9.7%) said they ever did so (P < .001). Although most physicians believed that at least 50% of cancer survivors would be adherent to medication regimens to prevent cancer recurrence, they also believed that, if patients were trying to lose weight, they would not remain medication-adherent. In interviews, oncologists expressed fear that providing health-promotion advice would distress or overwhelm patients. Additional health-promotion barriers identified by thematic analysis included: identifying cancer as oncologists' focal concern, time pressure, insufficient behavior change training, and care coordination challenges. Facilitators included perceiving a patient benefit and having health-promotion resources integrated into the cancer care system. CONCLUSIONS Physicians often do not have the time, expertise, or resources to address health promotion with cancer survivors. Research is needed to evaluate whether health-promotion efforts compromise medical regimen adherence, as physicians' responses suggest.
Collapse
Affiliation(s)
- Tammy K Stump
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - June K Robinson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Betina Yanez
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Adaeze Ezeofor
- School of Medicine, Howard University, Washington, District of Columbia
| | - Sheetal Kircher
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| |
Collapse
|
47
|
Fox RS, Moreno PI, Yanez B, Estabrook R, Thomas J, Bouchard LC, McGinty HL, Mohr DC, Begale MJ, Flury SC, Perry KT, Kundu SD, Penedo FJ. Integrating PROMIS® computerized adaptive tests into a web-based intervention for prostate cancer. Health Psychol 2019; 38:403-409. [PMID: 31045423 DOI: 10.1037/hea0000672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study outlined the implementation and feasibility of delivering PROMIS® computer adaptive tests (CATs) using a web-based method to evaluate the impact of a technological adaptation of Cognitive-Behavioral Stress Management (CBSM) on the psychosocial functioning of men with advanced prostate cancer (APC) undergoing hormone therapy. METHOD Patients were randomized to a CBSM group intervention (n = 95) or a health promotion (HP) attention-matched control condition (n = 97). Participants attended all sessions via video conference using tablets, and completed PROMIS® computer adaptive tests (CATs) assessing anxiety, depression, fatigue, pain interference, and physical function weekly during the 10-week intervention. RESULTS Assessment completion rates >50% at week 1 and week 10 demonstrated moderate feasibility of repeatedly administering PROMIS® CATs using a web-based method. Multilevel modeling demonstrated no significant group-by-time interactions from week 1 to week 10 for any of the assessed PROMIS® domains adjusting for sociodemographic and medical covariates. However, simple effects demonstrated decreases in PROMIS® anxiety scores from week 1 to 10 for both groups. Results also demonstrated significant relationships of medical variables to psychosocial functioning across time points. CONCLUSIONS Results highlight the feasibility and benefits of utilizing PROMIS® CATs to repeatedly assess psychosocial functioning using a web-based method and indicate that web-based interventions may be effective for decreasing psychosocial distress and adverse symptoms among men with APC undergoing hormone therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Patricia I Moreno
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Ryne Estabrook
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Jessica Thomas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Laura C Bouchard
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - Heather L McGinty
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center
| | - David C Mohr
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | | | - Sarah C Flury
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine
| | - Kent T Perry
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine
| | - Shilajit D Kundu
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine
| | - Frank J Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| |
Collapse
|
48
|
Moreno PI, Yanez B, Schuetz SJ, Wortman K, Gallo LC, Benedict C, Brintz CE, Cai J, Castaneda SF, Perreira KM, Gonzalez P, Gonzalez F, Isasi CR, Penedo FJ. Cancer fatalism and adherence to national cancer screening guidelines: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Cancer Epidemiol 2019; 60:39-45. [PMID: 30904827 PMCID: PMC10424711 DOI: 10.1016/j.canep.2019.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 02/05/2019] [Accepted: 03/03/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sociocultural factors, such as health insurance status, income, education, and acculturation, predict cancer screening among U.S. Hispanics/Latinos. However, these factors can be difficult to modify. More research is needed to identify individual-level modifiable factors that may improve screening and subsequent cancer outcomes in this population. The aim of this study was to examine cancer fatalism (i.e., the belief that there is little or nothing one can do to lower his/her risk of developing cancer) as a determinant of adherence to national screening guidelines for colorectal, breast, prostate, and cervical cancer among Hispanics/Latinos. METHODS Participants were from the multi-site Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (N = 5313). The National Cancer Institute (NCI) Health Interview National Trends Survey was used to assess cancer fatalism and receipt of cancer screening. Adherence was defined as following screening guidelines from United States Preventive Services Task Force and the American Cancer Society during the study period. RESULTS Adjusting for well-established determinants of cancer screening and covariates (health insurance status, income, education, acculturation, age, Hispanic/Latino background), lower cancer fatalism was marginally associated with greater adherence to screening for colorectal (OR 1.13, 95% CI [.99-1.30], p = .07), breast (OR 1.16, 95% CI [.99-1.36], p = .08) and prostate cancer (OR 1.18, 95% CI [.97-1.43], p = .10), but not cervical cancer. CONCLUSIONS The associations of cancer fatalism were small and marginal, underlining that sociocultural factors are more robust determinants of cancer screening adherence among Hispanics/Latinos.
Collapse
Affiliation(s)
- Patricia I Moreno
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Steven J Schuetz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Katy Wortman
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Linda C Gallo
- Department of Psychology, San Diego State University, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Catherine Benedict
- Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, United States
| | - Carrie E Brintz
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sheila F Castaneda
- Graduate School of Public Health, San Diego State University, San Diego, CA, United States
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, San Diego, CA, United States
| | - Franklyn Gonzalez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carmen R Isasi
- Departments of Epidemiology & Population Health and Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Frank J Penedo
- Department of Psychology and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States.
| |
Collapse
|
49
|
Yanez B, Bouchard LC, Cella D, Sosman JA, Kircher SM, Mohindra NA, Cristofanilli M, Penedo FJ. Patient-centered engagement and symptom/toxicity monitoring in the new era of tumor next-generation sequencing and immunotherapy: The OncoTool and OncoPRO platforms. Cancer 2019; 125:2338-2344. [PMID: 31034599 DOI: 10.1002/cncr.32030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura C Bouchard
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey A Sosman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheetal M Kircher
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nisha A Mohindra
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Massimo Cristofanilli
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Miami, Florida
| |
Collapse
|
50
|
Behrman P, Demirci J, Yanez B, Beharie N, Laroche H. Society of Behavioral Medicine (SBM) position statement: SBM urges Congress to preserve and increase the financing of federally funded nutrition assistance programs and services. Transl Behav Med 2019; 9:170-174. [PMID: 29726980 DOI: 10.1093/tbm/iby025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Deep cuts have been proposed to federally funded nutrition assistance programs, including the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and federally subsidized school breakfast and lunch programs. Yet, these programs help parents afford healthy meals for their families, pregnant and postpartum mothers access supplemental foods and health services for themselves and their infants and young children, and children obtain the nutrition necessary for optimal school performance. Participation in these programs is linked with reductions in perinatal morbidity and mortality, improved childhood growth trajectories, enhanced school performance, and reductions in food insecurity and poverty. Given these compelling health and economic benefits, the Society of Behavioral Medicine urges Congress to protect and increase funding for federally funded nutrition assistance programs, specifically SNAP, WIC, and school breakfast and lunch programs. Per the recent (2017) recommendations of the School Nutrition Association, Congress should also resist any attempts to "block-grant" subsidized school breakfast and lunch programs, which could reduce access to these programs. It is further recommended that Congress improve the scope of implementation- and outcomes-based assessments of these programs. Finally, we recommend efforts to increase awareness of and participation in SNAP, WIC, and federally funded school meal programs for eligible individuals, children, and families.
Collapse
Affiliation(s)
- Pamela Behrman
- Department of Psychology, College of Mt. St. Vincent, Bronx, NY, USA
| | - Jill Demirci
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nisha Beharie
- New York University School of Nursing, New York, NY, USA
| | - Helena Laroche
- Carver School of Medicine, University of Iowa Health Care, Coralville, IA, USA
| |
Collapse
|