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Bilenduke E, Anderson S, Brenner A, Currier J, Eberth JM, King J, Land SR, Risendal BC, Shannon J, Siegel LN, Wangen M, Waters AR, Zahnd WE, Studts JL. Equitable implementation of lung cancer screening: avoiding its potential to mirror existing inequities among people who use tobacco. Cancer Causes Control 2023; 34:209-216. [PMID: 37713024 PMCID: PMC10689540 DOI: 10.1007/s10552-023-01790-z] [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: 11/14/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Lung cancer is the leading cause of cancer death, but the advent of lung cancer screening using low-dose computed tomography offers a tremendous opportunity to improve lung cancer outcomes. Unfortunately, implementation of lung cancer screening has been hampered by substantial barriers and remains suboptimal. Specifically, the commentary emphasizes the intersectionality of smoking history and several important sociodemographic characteristics and identities that should inform lung cancer screening outreach and engagement efforts, including socioeconomic considerations (e.g., health insurance status), racial and ethnic identity, LGBTQ + identity, mental health history, military experience/veteran status, and geographic residence in addressing specific community risk factors and future interventions in efforts to make strides toward equitable lung cancer screening. METHODS Members of the Equitable Implementation of Lung Cancer Screening Interest Group with the Cancer Prevention and Control Network (CPCRN) provide a critical commentary based on existing literature regarding smoking trends in the US and lung cancer screening uptake to propose opportunities to enhance implementation and support equitable distribution of the benefits of lung cancer screening. CONCLUSION The present commentary utilizes information about historical trends in tobacco use to highlight opportunities for targeted outreach efforts to engage communities at high risk with information about the lung cancer screening opportunity. Future efforts toward equitable implementation of lung cancer screening should focus on multi-level implementation strategies that engage and work in concert with community partners to co-create approaches that leverage strengths and reduce barriers within specific communities to achieve the potential of lung cancer screening.
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Affiliation(s)
- Emily Bilenduke
- Department of Psychology, University of Colorado Denver, Denver, CO, USA.
| | - Shacoria Anderson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alison Brenner
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica Currier
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Jaron King
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Stephanie R Land
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Cancer Prevention and Control Program, University of Colorado Cancer Center, Aurora, CO, USA
| | - Jackilen Shannon
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Leeann N Siegel
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Austin R Waters
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jamie L Studts
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, USA.
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Bilenduke E, Dwyer AJ, Staples ES, Kilbourn K, Valverde PA, Fernández ME, Risendal BC. A practical method for integrating community priorities in planning and implementing cancer control programs. Cancer Causes Control 2023; 34:113-123. [PMID: 37069456 PMCID: PMC10110487 DOI: 10.1007/s10552-023-01688-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Community engagement is essential in effective public health programs. This paper illustrates the methods used to engage community in the development of a multi-level implementation intervention to address cancer disparities related to hereditary cancer syndromes. METHODS Implementation Mapping (IM), was used to guide the co-creation of an intervention. Key partners were recruited to a 13-member statewide community advisory board (CAB) representing healthcare and community-based organizations. As part of a needs assessment, a 3-round modified Delphi method with the CAB was used to identify implementation outcomes to use in later steps of IM. An anonymous online survey of a validated community engagement measure assessed CAB members' satisfaction with the process. RESULTS Using a modified Delphi method as part of the needs assessment of IM, the CAB identified three broad categories of strategies: Changing infrastructure using patient navigation; training and educating patients, navigators and providers; and supporting clinicians in case identification and management. Self-reported satisfaction with the IM and Delphi process was high. CONCLUSIONS Implementation Mapping facilitated the use of available evidence, new data, and community engagement to identify strategies to improve the delivery of programs to reduce hereditary cancer disparities. The modified Delphi method was easy to administer in a virtual environment and may be a useful for others in community-engaged research.
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Affiliation(s)
- Emily Bilenduke
- Department of Psychology, University of Colorado Denver, Denver, CO, USA.
| | - Andrea J Dwyer
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Elsa S Staples
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Patricia A Valverde
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Maria E Fernández
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
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Chebli P, Adsul P, Kranick J, Rohweder CL, Risendal BC, Bilenduke E, Williams R, Wheeler S, Kwon SC, Trinh-Shevrin C. Principles to operationalize equity in cancer research and health outcomes: lessons learned from the cancer prevention and control research network. Cancer Causes Control 2023; 34:371-387. [PMID: 36781715 PMCID: PMC9925365 DOI: 10.1007/s10552-023-01668-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023]
Abstract
Reflecting their commitment to advancing health equity, the Cancer Prevention and Control Research Network (CPCRN) established a Health Equity Workgroup to identify and distill guiding principles rooted in health equity, community-engaged participatory research (CBPR), social determinants of health, and racial equity frameworks to guide its collective work. The Health Equity Workgroup utilized a multi-phase, participatory consensus-building approach to: (1) identify recurrent themes in health and racial equity frameworks; (2) capture perspectives on and experiences with health equity research among CPCRN members through an online survey; (3) engage in activities to discuss and refine the guiding principles; and (4) collect case examples of operationalizing equity principles in cancer research. Representatives from all CPCRN centers endorsed nine core principles to guide the Network's strategic plan: (1) Engage in power-sharing and capacity building with partners; (2) Address community priorities through community engagement and co-creation of research; (3) Explore and address the systems and structural root causes of cancer disparities; (4) Build a system of accountability between research and community partners; (5) Establish transparent relationships with community partners; (6) Prioritize the sustainability of research benefits for community partners; (7) Center racial equity in cancer prevention and control research; (8) Engage in equitable data collection, analysis, interpretation, and dissemination practices; and (9) Integrate knowledge translation, implementation, and dissemination into research plans. Dissemination products, such as toolkits and technical assistance workshops, reflecting these principles will foster knowledge transfer to intentionally integrate health and racial equity principles in cancer prevention and control research.
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Affiliation(s)
- Perla Chebli
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA.
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Cancer Control and Populations Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Julie Kranick
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy C Risendal
- Colorado School of Public Health, University of Colorado Cancer Center, Aurora, CO, USA
| | - Emily Bilenduke
- Department of Psychology Denver, University of Colorado Denver, Denver, CO, USA
| | - Rebecca Williams
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Wheeler
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Simona C Kwon
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, Section for Health Equity, NYU Grossman School of Medicine, 180 Madison Avenue, 8th Fl. #8-21A, New York, NY, 10016, USA
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Dwyer AJ, Weltzien ES, Harty NM, LeGrice KE, Pray SLH, Risendal BC. What makes for successful patient navigation implementation in cancer prevention and screening programs using an evaluation and sustainability framework. Cancer 2022; 128 Suppl 13:2636-2648. [PMID: 35699619 DOI: 10.1002/cncr.34058] [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: 02/10/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Integrating patient navigation into cancer prevention and early detection efforts has been effective in increasing cancer screening rates for the medically underserved. Few publications have focused on how cancer screening interventions in the primary care setting using patient navigation as a primary strategy are implemented, adapted, and sustained. In 2006, the University of Colorado Cancer Center established a statewide colorectal cancer screening program to reduce disparities and improve colorectal cancer (CRC) screening for the medically underserved in partnership with the safety net system. The program, known as the Colorado Cancer Screening Program (CCSP), has provided navigation into preventive screening for more than 35,000 patients. METHODS To evaluate sustainability and implementation, the Practical, Robust Implementation and Sustainability Model was used to examine the implementation and impact. To complement this model, the CCSP adapted the Program Sustainability Framework and Clinical Sustainability Framework and Assessment Tools to measure the capacity of participating clinics to sustain the program beyond grant funding. RESULTS The domains most frequently targeted for improvement in the sustainability plans were Workflow Integration (8 clinics), Communication, Planning, and Implementation (8 clinics), and Funding Stability (5 clinics). Activities in the implementation plans included revising workflows for efficiencies, incorporating quality improvement strategies, and building a business case for patient navigation. CONCLUSIONS Findings from this sustainability planning process provide insight about program outcomes, satisfaction, and illustrate that although funding remains one of the key sustainability questions, many clinic systems have prioritized other specific domains to continue sustainability beyond grant funding.
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Affiliation(s)
- Andrea J Dwyer
- University of Colorado Cancer Center, Aurora, Colorado.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Elsa S Weltzien
- University of Colorado Cancer Center, Aurora, Colorado.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Nicole M Harty
- University of Colorado Cancer Center, Aurora, Colorado.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Kirsten E LeGrice
- University of Colorado Cancer Center, Aurora, Colorado.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Shannon L H Pray
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Betsy C Risendal
- University of Colorado Cancer Center, Aurora, Colorado.,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
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Tektiridis JH, Heredia NI, Morgan RO, Mikhail OI, Risendal BC, Kegler MC, Fernandez ME. Practice change in community health centers: A qualitative study of leadership attributes. Front Health Serv 2022; 2:934688. [PMID: 36925826 PMCID: PMC10012757 DOI: 10.3389/frhs.2022.934688] [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] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022]
Abstract
Introduction This paper explores leadership attributes important for practice change in community health centers (CHCs) and assesses attributes' fit with the Full-Range Leadership Theory (FRLT). Methods We conducted four focus groups and 15 in-depth interviews with 48 CHC leaders from several U.S. states using a modified appreciative inquiry approach. Thematic analysis was used to review transcripts for leadership concepts and code with a priori FRLT-derived and inductive codes. Results CHC leaders most often noted attributes associated with transformational leadership as essential for practice change. Important attributes included emphasizing a collective sense of mission and a compelling, achievable vision; expressing enthusiasm about what needs to be done; and appealing to employees' analytical reasoning and challenging others to think creatively to problem solve. Few expressions of leadership fit with the transactional typology, though some did mention active vigilance to ensure standards are met, clarifying role and task requirements, and rewarding followers. Passive-avoidant attributes were rarely mentioned. Conclusions Our results enhance understanding of leadership attributes supportive of successful practice change in CHCs.
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Affiliation(s)
| | - Natalia I Heredia
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Robert O Morgan
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Osama I Mikhail
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Betsy C Risendal
- Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
| | - Michelle C Kegler
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Risendal BC, Hébert JR, Morrato EH, Thomson CA, Escoffery CN, Friedman DB, Dwyer AJ, Overholser LS, Wheeler SB. Addressing COVID-19 Using a Public Health Approach: Perspectives From the Cancer Prevention and Control Research Network. Am J Prev Med 2021; 60:877-882. [PMID: 33785276 PMCID: PMC7900782 DOI: 10.1016/j.amepre.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Betsy C Risendal
- Community & Behavioral Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; The Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Elaine H Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois
| | - Cynthia A Thomson
- Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona; Population Sciences, University of Arizona Cancer Center, Tucson, Arizona.
| | - Cam N Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Linda S Overholser
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Ketterl TG, McCabe MS, Rosenstein DL, Jacobs LA, Palmer SC, Ganz PA, Casillas JN, Risendal BC, Overholser L, Partridge AH, Syrjala KL, Baker KS. Impact of cancer on physical and mental activities of daily living in young adult (YA) survivors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
11517 Background: Young Adult (YA) survivors face challenges unique from those survivors of childhood cancer or of middle and older age adults. The potential impact of cancer, its treatment or the lasting effects on daily mental and physical tasks are not fully understood. Methods: Eligibility included diagnosis of malignancy between ages 18-39, 1-5 years from diagnosis and ≥1 year from therapy completion. Participants were randomly selected from tumor registries of 7 academic institutions. Enrolled participants were asked to complete an online patient reported outcomes (PRO) survey related to the effects of cancer and its treatment on daily functionality, finances, and cancer-related distress. All enrolled subjects had diagnostic and treatment information abstracted by a standardized protocol and entered into a database. Results: Enrollment and the online PRO survey was completed by 872 survivors (43.5% of eligible survivors). Survivors were 72.3% female, 90% non-Hispanic or Latino and the most common cancer for males and females were testicular and breast cancer respectively. Cancer, its treatment or the lasting effects limited the kind or amount of instrumental activities of daily living (IADLs) in 649 (76.3%) of survivors. Exposure to chemotherapy was associated with a 3.2-fold increased odds of interference with IADLs (CI 2.08-4.83, p < 0.01) after controlling for diagnosis, age, gender, radiation and surgery exposure. This impairment lasted longer than 1 year in 268 (41.3%) of survivors. Cancer, its treatment or the lasting effects interfered with their ability to perform any mental tasks as part of their IADLs in 454 (53.3%) of survivors. Exposure to chemotherapy was associated with a 2.8-fold increased odds of interference with mental impairment of IADLs (CI 1.94-3.96, p < 0.01) after controlling for diagnosis, age, gender, radiation and surgery exposure. Exposure to radiation was also associated with an increased odds of interference with mental impairment of daily activities (CI 1.05-1.91, p < 0.01) after controlling for diagnosis, age, gender, chemotherapy and surgery exposure. Conclusions: In YA cancer survivors, cancer, its treatment or the lasting effects of treatment commonly impact the daily physical and mental IADLs and many survivors report ongoing limitations > 1 year from therapy completion.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center & University of Washington, Department of Public Health, Seattle, WA
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Valverde PA, Calhoun E, Esparza A, Wells KJ, Risendal BC. The early dissemination of patient navigation interventions: results of a respondent-driven sample survey. Transl Behav Med 2018; 8:456-467. [PMID: 29800405 DOI: 10.1093/tbm/ibx080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] Open
Abstract
Patient navigators (PNs) coordinate medical services and connect patients with resources to improve outcomes, satisfaction, and reduce costs. Little national information is available to inform workforce development. We analyzed 819 responses from an online PN survey conducted in 2009-2010. Study variables were mapped to the five Consolidated Framework for Implementation Research (CFIR) constructs to explore program variations by type of PN. Five logistic regression models compared each PN type to all others while adjusting for covariates. Thirty-five percent of respondents were nurse navigators, 28% lay navigators, 20% social work (SW)/counselor navigators, 7% allied health navigators, and 10% were "other" types of PNs. Most were non-Hispanic White (71%), female (94%), and at least college educated (70%). The primary differences were observed among: the core intervention tasks; position structure; work setting; health conditions navigated; navigator race/ethnicity; personal cancer experiences; navigation training; and patient populations served. Lay PNs had fewer odds of identifying as Hispanic, work in rural settings and assist underserved populations compared to others. Nurse navigators showed greater odds of clinical responsibilities, work in hospital or government settings and fewer odds of navigating minority populations compared to others. SW/counselor navigators also had additional duties, provided greater assistance to Medicare patient populations, and less odds of navigating underserved populations than others. In summary, our survey indicates that the type of PN utilized is an indicator of other substantial differences in program implementation. CFIR provides a robust method to compare differences and should incorporate care coordination outcomes in future PN research.
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Affiliation(s)
- Patricia A Valverde
- Department of Community and Behavioral Health, School of Public Health, Aurora, CO
| | - Elizabeth Calhoun
- University of Arizona, Office of the Senior Vice President for Health Sciences, Vice President for Population Health Sciences, Executive Director, Center for Population Science and Discovery, Roy P. Drachman Hall, Tucson, AZ
| | - Angelina Esparza
- Executive Staff Analyst/Chief Program Officer, Houston Department for Health and Human Services, Houston, TX
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO
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Ketterl TG, Casillas JN, Ganz PA, Jacobs LA, McCabe MS, Palmer SC, Partridge AH, Rajotte EJ, Risendal BC, Rosenstein D, Syrjala KL, Baker KS. Impact of cancer on employment and finances in young adult (YA) survivors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rosenberg SM, Partridge AH, Poorvu PD, Casillas JN, Ganz PA, Jacobs LA, McCabe MS, Overholser L, Palmer SC, Rajotte EJ, Risendal BC, Rosenstein D, Syrjala KL, Baker KS. Fertility preservation use and outcomes among young adult cancer survivors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.115] [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
115 Background: Fertility is a critical survivorship issue for young adults (YA) with cancer. Data regarding use of fertility preservation (FP) and fertility outcomes in this population are limited. Methods: In 2013-2014, 868 patients, aged 18-39, 1-5 years post diagnosis (dx) of an invasive cancer completed a survey about the impacts of cancer and treatment including fertility. Descriptive statistics were used to characterize FP options pursued, reasons for not undergoing FP, and pregnancy outcomes. Logistic regression was used to identify factors associated with pre- treatment FP. Results: Median age at dx was 32. Most respondents were female (73%), married (61%), with a college degree (71%). Breast (28%), thyroid (15%), and lymphoma (13%) were the most common dx. 13% (77/614) of women and 36% (82/231) of men reported FP attempts prior to treatment, including 57% of testicular, 39% of lymphoma, 27% of leukemia, and 18% of breast cancer survivors. In men, sperm banking (96%) was the most common approach; in women, embryo (47%) and oocyte (23%) cryopreservation. Of those who did not pursue FP (N=686), 19% reported lack of information on risks/options as the reason. In multivariable analyses, FP was associated (p<0.05) with male gender, younger age, chemotherapy, being married, and having a college degree; survivors who had children prior to dx were less likely to pursue FP (Table). Of 60 men who tried to father a pregnancy, 42 (70%) were successful and 37 (88%) conceived naturally. Of 114 women who attempted pregnancy, 83 (73%) were successful, 76 (92%) conceived naturally. Conclusions: Some YA patients are not aware of treatment risks and FP options, indicating that fertility may be under-addressed. In our sample, nearly all patients who reported attempting pregnancy within 5 years of dx conceived naturally, suggesting that a risk stratified approach may help optimize use of FP services. [Table: see text]
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Wells KJ, Valverde P, Ustjanauskas AE, Calhoun EA, Risendal BC. What are patient navigators doing, for whom, and where? A national survey evaluating the types of services provided by patient navigators. Patient Educ Couns 2018; 101:285-294. [PMID: 28935442 PMCID: PMC5808907 DOI: 10.1016/j.pec.2017.08.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/01/2017] [Accepted: 08/28/2017] [Indexed: 05/12/2023]
Abstract
OBJECTIVE A nationwide cross-sectional study was conducted to assess patient navigator, patient population, and work setting characteristics associated with performance of various patient navigation (PN) tasks. METHODS Using respondent-driven sampling, 819 navigators completed a survey assessing frequency of providing 83 PN services, along with information about themselves, populations they serve, and setting in which they worked. Analyses of variance and Pearson correlations were conducted to determine differences and associations in frequency of PN services provided by various patient, navigator, and work setting characteristics. RESULTS Nurse navigators and navigators with lower education provide basic navigation; social workers typically made arrangements and referrals; and individuals with higher education, social workers, and nurses provide treatment support and clinical trials/peer support. Treatment support and clinical trials/peer support are provided to individuals with private insurance. Basic navigation, arrangements and referrals, and care coordination are provided to individuals with Medicaid or no insurance. CONCLUSION Providing basic navigation is a core competency for patient navigators. There may be two different specialties of PN, one which seeks to reduce health disparities and a second which focuses on treatment and emotional support. PRACTICE IMPLICATIONS The selection and training of patient navigators should reflect the specialization required for a position.
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Affiliation(s)
- Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, USA; University of California, San Diego Moores Cancer Center, La Jolla, USA.
| | - Patricia Valverde
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, USA
| | - Amy E Ustjanauskas
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Elizabeth A Calhoun
- Department of Public Health Policy and Management, University of Arizona Health Sciences, Tucson, USA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, USA
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12
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Baker KS, Ambrose K, Arvey SR, Casillas JN, Ganz PA, Jacobs LA, McCabe MS, Overholser L, Partridge AH, Rajotte EJ, Risendal BC, Rosenstein D, Syrjala K. Financial and work related impact of cancer in young adult (YA) survivors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15 Background: YA survivors face challenges unique from those of survivors of childhood cancer or of older adults. The potential impact of cancer or its treatment upon employment and finances for YA survivors is unknown. Methods: Eligibility included diagnosis of malignancy between ages 18-39, 1-5 years from diagnosis and > 1 year from therapy completion. Participants (see Table) were randomly selected from tumor registries of 7 academic institutions; 875 (41% of attempted contacts) enrolled and completed online patient reported outcomes survey related to the effects of cancer/treatment on employment, finances, and cancer-related distress. Results: Overall 84% were employed sometime between cancer diagnosis and study enrollment. Of those, 76% took paid time off (40% < 2 mo, 29% 2-5 mo, 31% > 6 mo). Unpaid time off was required by 39% (37% < 2 mo, 25% 2-5 mo, 38% > 6 mo). Other impairments included inability to carry out physical (59%) or mental (55%) tasks required for their job, being less productive (67%), and not pursuing an advancement/promotion (21%). Financial impacts were substantial: 61% worried about medical bills, 31% went into debt related to their cancer/treatment. Of those incurring debt, most (53%) reported this amount to be < $10,000, 29% $10,000-$24,999, and 18% > $25,000; 13 (4.8%) filed for bankruptcy. Chi squares comparing those receiving extensive treatment vs. surgery only indicated greater likelihood of financial debt (10.6, P=.001) and residual distress (13.9, P < .001) if treated with more than surgery. Conclusions: Most YA survivors experience a significant negative impact on employment and finances related to their cancer and treatment, which occurs at a critical time in their careers and at a life phase inherently more financially unstable. Longitudinal follow-up is required to better quantify the long-term burden on work and finances from cancer diagnosed in young adulthood. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Linda A. Jacobs
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
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13
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14
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Risendal BC, Dwyer A, Seidel RW, Lorig K, Coombs L, Ory MG. Meeting the challenge of cancer survivorship in public health: results from the evaluation of the chronic disease self-management program for cancer survivors. Front Public Health 2015; 2:214. [PMID: 25964922 PMCID: PMC4410485 DOI: 10.3389/fpubh.2014.00214] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 06/18/2014] [Accepted: 10/14/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction Self-management has been identified as an important opportunity to improve health outcomes among cancer survivors. However, few evidence-based interventions are available to meet this need. Methods The effectiveness of an adapted version of the Chronic Disease Self-Management Program for cancer survivors called Cancer Thriving and Surviving was evaluated in a randomized trial. Outcomes were assessed at baseline and 6-months post program via written survey among 244 participants in Colorado. Repeated measures analysis was used to analyze pre/post program change. Results Statistically significant improvement was observed among those in the intervention in the following outcomes: Provider communication (+16.7% change); depression (−19.1%); energy (+13.8%); sleep (−24.9%) and stress-related problems (−19.2%); change over time was also observed in the controls for energy, sleep, and stress-related outcomes though to a lesser degree. Effect sizes of the difference in change over time observed indicate a net beneficial effect for provider communication (0.23); and decreases in depression (−0.18); pain (−0.19); problems related to stress (−0.17); and sleep (−0.20). Conclusion Study data suggest that the self-management support from adaptation of the CDSMP can reach and appeal to cancer survivors, improves common concerns in this population, and can fill an important gap in meeting the ongoing need for management of post-diagnosis issues in this growing segment of the U.S. population.
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Affiliation(s)
- Betsy C Risendal
- Community and Behavioral Health, Colorado School of Public Health , Aurora, CO , USA
| | - Andrea Dwyer
- Community and Behavioral Health, Colorado School of Public Health , Aurora, CO , USA
| | - Richard W Seidel
- Carilion Clinic, Virginia Tech Carilion School of Medicine , Roanoke, VA , USA
| | - Kate Lorig
- School of Medicine, Stanford University , Stanford, CA , USA
| | - Letoynia Coombs
- Colorado Health Outcomes, University of Colorado , Aurora, CO , USA
| | - Marcia G Ory
- Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Public Health , College Station, TX , USA
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15
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Tu SP, Young VM, Coombs LJ, Williams RS, Kegler MC, Kimura AT, Risendal BC, Friedman DB, Glenn BA, Pfeiffer DJ, Fernandez ME. Practice adaptive reserve and colorectal cancer screening best practices at community health center clinics in 7 states. Cancer 2014; 121:1241-8. [PMID: 25524651 DOI: 10.1002/cncr.29176] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/14/2014] [Accepted: 11/04/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Enhancing the capability of community health centers to implement best practices (BPs) may mitigate health disparities. This study investigated the association of practice adaptive reserve (PAR) with the implementation of patient-centered medical home (PCMH) colorectal cancer (CRC) screening BPs at community health center clinics in 7 states. METHODS A convenience sample of clinic staff participated in a self-administered, online survey. Eight PCMH CRC screening BPs were scored as a composite ranging from 0 to 32. The PAR composite score was scaled from 0 to 1 and then categorized into 3 levels. Multilevel analyses examined the relation between PAR and self-reported implementation of PCMH BPs. RESULTS There were 296 respondents, and 59% reported 6 or more PCMH BPs at their clinics. The mean PAR score was 0.66 (standard deviation, 0.18), and the PCMH BP mean scores were significantly higher for respondents who reported higher clinic PAR categories. In comparison with the lowest PAR level, adjusted PCMH BP means were 25.0% higher at the middle PAR level (difference, 3.2; standard error, 1.3; t = 2.44; P = .015) and 63.2% higher at the highest PAR level (difference, 8.0; standard error, 1.9; t = 4.86; P < .0001). CONCLUSIONS A higher adaptive reserve, as measured by the PAR score, was positively associated with self-reported implementation of PCMH CRC screening BPs by clinic staff. Future research is needed to determine the PAR levels most conducive to implementing CRC screening and to develop interventions that enhance PAR in primary care settings.
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Affiliation(s)
- Shin-Ping Tu
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia; Department of Health Services, University of Washington, Seattle, Washington
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Fernández ME, Melvin CL, Leeman J, Ribisl KM, Allen JD, Kegler MC, Bastani R, Ory MG, Risendal BC, Hannon PA, Kreuter MW, Hebert JR. The cancer prevention and control research network: An interactive systems approach to advancing cancer control implementation research and practice. Cancer Epidemiol Biomarkers Prev 2014; 23:2512-21. [PMID: 25155759 PMCID: PMC6013073 DOI: 10.1158/1055-9965.epi-14-0097] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions. METHODS The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model. RESULTS We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice. CONCLUSIONS The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control. IMPACT Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them.
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Affiliation(s)
- María E Fernández
- Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina. Center for Health Promotion and Disease Prevention and Lineberger Comprehensive Cancer Center, and
| | - Kurt M Ribisl
- Center for Health Promotion and Disease Prevention and Lineberger Comprehensive Cancer Center, and Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer D Allen
- Department of Public Health and Community Medicine, Tufts University, Medford, Massachusetts
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roshan Bastani
- UCLA Department of Health Policy and Management, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Marcia G Ory
- Texas A&M Health Science Center, School of Public Health, Department of Health Promotion and Community Health Sciences, College Station, Texas
| | - Betsy C Risendal
- University of Colorado School of Public Health, Denver, Colorado
| | - Peggy A Hannon
- Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St Louis, Missouri
| | - James R Hebert
- Department of Biostatistics and Epidemiology and Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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17
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Escoffery C, Rodgers KC, Kegler MC, Haardörfer R, Howard DH, Liang S, Pinsker E, Roland KB, Allen JD, Ory MG, Bastani R, Fernandez ME, Risendal BC, Byrd TL, Coronado GD. A systematic review of special events to promote breast, cervical and colorectal cancer screening in the United States. BMC Public Health 2014; 14:274. [PMID: 24661503 PMCID: PMC3987802 DOI: 10.1186/1471-2458-14-274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/06/2014] [Indexed: 12/03/2022] Open
Abstract
Background Special events are common community-based strategies for health promotion. This paper presents findings from a systematic literature review on the impact of special events to promote breast, cervical or colorectal cancer education and screening. Methods Articles in English that focused on special events involving breast, cervical, and/or colorectal cancer conducted in the U.S. and published between January 1990 and December 2011 were identified from seven databases: Ovid, Web of Science, CINAHL, PsycINFO, Sociological Abstract, Cochrane Libraries, and EconLit. Study inclusion and data extraction were independently validated by two researchers. Results Of the 20 articles selected for screening out of 1,409, ten articles on special events reported outcome data. Five types of special events were found: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. Reach ranged from 50–1732 participants. All special events used at least one evidence-based strategy suggested by the Community Guide to Preventive Services, such as small media, one-on-one education, and reducing structural barriers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening. Conclusions Special events found in the review varied and used evidence-based strategies. Screening data suggest that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening. The heterogeneity of populations served, event activities, outcome variables assessed, and the reliance on self-report to measure screening limit conclusions. This study highlights the need for further research to determine the effectiveness of special events to increase cancer screening.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, USA.
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18
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Sedjo RL, Hines LM, Byers T, Giuliano AR, Marcus A, Vadaparampil S, Jacobsen P, Kilbourn K, Feser WJ, Risendal BC. Long-term weight gain among Hispanic and non-Hispanic White women with and without breast cancer. Nutr Cancer 2013; 65:34-42. [PMID: 23368911 DOI: 10.1080/01635581.2013.741750] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Weight gain following breast cancer diagnosis is common, but limited data exists on whether this gain is in excess of that gained during normal aging. This study investigated weight patterns among women with and without breast cancer to determine the effects of the breast cancer experience on weight change. Using the SHINE 4-Corners Breast Cancer Study, 305 women with breast cancer and 345 women without were followed prospectively. Weight change of ≥5% was defined as the difference between the self-reported weight measurements obtained at breast cancer diagnosis (or referent date for women without breast cancer) and about 6 yr later. Multiple logistic regression analyses were used. Within this cohort, 60% of women were overweight or obese and 37% of women gained weight. No significant greater weight gain was observed between women with vs. without breast cancer [adjusted odds ratio (ORadj) = 1.15, 95% CI 0.79-1.68] or between Hispanic vs. non-Hispanic White women (ORadj = 1.09, 95% CI 0.72-1.66) after adjustment. Weight gain was associated with being younger and having a lower body mass index. Among breast cancer survivors, cancer treatment factors were not associated with weight gain. These results suggest that weight management approaches are needed, especially those targeted to at-risk populations such as breast cancer survivors.
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Affiliation(s)
- Rebecca L Sedjo
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado 80045, USA
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Lowery JT, Risendal BC. A population perspective to mitigating risk for second primary breast cancer. Breast Cancer Management 2013. [DOI: 10.2217/bmt.13.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY There are more than 2 million breast cancer survivors in the USA. Approximately 5–10% of survivors will develop a second, metachronous breast cancer within 10 years’ time; a risk two- to six-times higher than that in the general population. Women who develop metachronous cancer are more likely to die from the disease compared with women with unilateral cancer. Risk factors for metachronous cancer include BRCA mutation status, young age, family history and tumor phenotype, while adjuvant chemotherapy and endocrine therapy may attenuate the risk. Surveillance guidelines recommend annual mammography, but MRI is not currently indicated for most women. An increasing number of women are choosing prophylactic contralateral mastectomy, although it is not likely to be beneficial for most women. Improved strategies are needed for identifying survivors at an increased risk in order to help guide clinical decisions regarding follow-up care. This review presents an overview of the burden and risk factors for metachronous breast cancer and discusses challenges and opportunities for a population approach to mitigating risk and adverse outcomes from these cancers.
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Affiliation(s)
- Jan T Lowery
- University of Colorado, School of Public Health, Department of Epidemiology, 13001 E 17th Place, Aurora, CO 80045, USA
- University of Colorado Cancer Center, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Betsy C Risendal
- University of Colorado Cancer Center, 13001 E 17th Place, Aurora, CO 80045, USA
- University of Colorado, School of Public Health, Department of Community & Behavioral Health, 13001 E 17th Place, Aurora, CO 80045, USA
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Yang D, Baumgartner RN, Slattery ML, Wang C, Giuliano AR, Murtaugh MA, Risendal BC, Byers T, Baumgartner KB. Dietary intake of folate, B-vitamins and methionine and breast cancer risk among Hispanic and non-Hispanic white women. PLoS One 2013; 8:e54495. [PMID: 23408942 PMCID: PMC3569453 DOI: 10.1371/journal.pone.0054495] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 12/12/2012] [Indexed: 11/25/2022] Open
Abstract
Background Low dietary folate intake is associated with several neoplasias, but reports are inconsistent for breast cancer. Additionally, the association of folate with breast cancer estrogen receptor (ER) status is not well established. Objective To determine if dietary intakes of folate, B-vitamins (B2, B6, B12) and methionine are associated with breast cancer risk and ER status in Hispanic, and non-Hispanic White women in the southwestern US. Materials and Methods Primary breast cancer cases (n = 2,325) in the 4-Corners region (Arizona, Colorado, New Mexico and Utah), diagnosed between October 1999 and May 2004, were identified through state cancer registries. Controls (n = 2,525) were frequency-matched by ethnicity and age (±5 years). Dietary intake, physical activity and other exposures were assessed using in-person interviews. Risk was assessed through multivariable and multinomial logistic regression with adjustment for relevant covariates. Result While there was no overall association with breast cancer, the highest quartile of folate intake was marginally inversely associated with ER− breast cancer (Odds Ratio (OR) = 0.50, 95%CI 0.25–1.00, p for trend = 0.07). Vitamin B12 intake was inversely associated with breast cancer also (OR = 0.73, 95%CI 0.53–1.00, p for trend = 0.06), particularly for the highest quartile of ER+ breast cancer (OR = 0.67, 95%CI 0.46–0.99, p for trend = 0.06), among NHW women (OR = 0.49, 95%CI 0.29–0.81, p for trend = 0.01) and invasive breast cancer (OR = 0.63; 95%CI: 0.42, 0.93, Ptrend = 0.01). Methionine intake was also inversely associated with ER+ breast cancer (OR for 4th quartile = 0.83, 95%CI 0.66–1.03, p for trend = 0.04), primarily among Hispanic women (OR = 0.71, 95%CI 0.47–1.06, and P for trend = 0.02). Conclusion Higher intake of folate is marginally associated with a lower risk for ER− breast cancer, and higher intakes of vitamin B-12 and methionine are marginally associated with a lower risk of ER+ breast cancer.
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Affiliation(s)
- Dongyan Yang
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Kentucky, USA.
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21
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Connor AE, Baumgartner RN, Yang D, Slattery ML, Giuliano AR, Risendal BC, Abdel-Maksoud MM, Baumgartner KB. Differences between Hispanic and non-Hispanic white women with breast cancer for clinical characteristics and their correlates. Ann Epidemiol 2013; 23:227-32. [PMID: 23369848 DOI: 10.1016/j.annepidem.2012.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/16/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Body size and ethnicity may influence breast cancer tumor characteristics at diagnosis. We compared Hispanic and non-Hispanic white (NHW) cases for stage of disease, estrogen receptor (ER) status, tumor size, and lymph node status, and the associations of these with body size in the 4-Corners Breast Cancer Study. METHODS One thousand five hundred twenty-seven NHW and 798 Hispanic primary incident breast cancer cases diagnosed between October 1999 and May 2004 were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multiple logistic regression. RESULTS Hispanic women were more likely to have larger (>1 cm) ER- tumors and more than four positive lymph nodes (P < .003). Lymph node status was not associated with body size. However, among NHW women, obesity (body mass index >30) and increased waist circumference (>38.5 inches) were significantly positively associated with ER- tumor status (OR, 1.87; 95% CI, 1.24-2.81 and OR, 2.59; 95% CI, 1.58-4.22, respectively). In contrast, among Hispanic women, obesity and waist circumference had inverse associations with ER- tumor status (OR, 0.49; 95% CI, 0.29-0.84 and OR, 0.56; 95% CI, 0.30-1.05, respectively). CONCLUSIONS Hispanic ethnicity may modify the association of body size and composition with ER- breast cancer. This finding could have relevance to clinical treatment and prognosis.
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Affiliation(s)
- Avonne E Connor
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, KY 40202, USA.
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22
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Connor A, Baumgartner RN, Kerber RA, O'Brien E, Rai SN, Wolff RK, Slattery ML, Giuliano AR, Risendal BC, Byers TE, Baumgartner KB. ADRB2 G-G haplotype associated with breast cancer risk among Hispanic and non-Hispanic white women: interaction with type 2 diabetes and obesity. Cancer Causes Control 2012; 23:1653-63. [PMID: 22864926 DOI: 10.1007/s10552-012-0043-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/25/2012] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Polymorphisms in the beta-2-adrenergic receptor (ADRB2) gene have been studied in relation to risk of type 2 diabetes and obesity, risk factors that have received increased attention in relation to breast cancer. We evaluated the hypothesis that ADRB2 variants (rs1042713, rs1042714) are associated with breast cancer risk in non-Hispanic white (NHW) and Hispanic (H) women using data from a population-based case-control study conducted in the southwestern United States. METHODS Data on lifestyle and medical history, and blood samples, were collected during in-person interviews for incident primary breast cancer cases (1,244 NHW, 606 H) and controls (1,330 NHW, 728 H). ADRB2 genotypes for rs1042713(G/A) and rs1042714(G/C) were determined using TaqMan assays. The associations of each variant and corresponding haplotypes with breast cancer were estimated using multivariable logistic regression. RESULTS Two copies compared to one or zero copies of the ADRB2 G-G haplotype were associated with increased breast cancer risk for NHW women [odds ratio (OR), 1.95; 95 % confidence interval (95 % CI), 1.26-3.01], but with reduced risk for H women [OR, 0.74; 95 % CI, 0.50-1.09]. Effect estimates were strengthened for women with a body mass index (BMI) ≥25 kg/m(2) [H: OR, 0.50; 95 % CI, 0.31-0.82; NHW: OR, 3.85; 95 % CI, 1.88-7.88] and for H women with a history of diabetes [H: OR, 0.32; 95 % CI, 0.12-0.89]. CONCLUSIONS These data suggest that ethnicity modifies the association between the ADRB2 G-G haplotype and breast cancer risk, and being overweight or obese enhances the divergence of risk between H and NHW women.
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Affiliation(s)
- Avonne Connor
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, USA.
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Pollack LA, Hawkins NA, Peaker BL, Buchanan N, Risendal BC. Dissemination and translation: a frontier for cancer survivorship research. Cancer Epidemiol Biomarkers Prev 2012; 20:2093-8. [PMID: 21980017 DOI: 10.1158/1055-9965.epi-11-0652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
As the field of survivorship research grows, the need for translation is imperative to expand new knowledge into arenas that directly impact survivors. This commentary seeks to encourage research focused on dissemination and translation of survivorship interventions and programs, including practice-based research. We overview diffusion, dissemination and translation in the context of cancer survivorship and present the RE-AIM and Knowledge to Action frameworks as approaches that can be used to expand research into communities. Many academic, governmental, and community-based organizations focus on cancer survivor. Future survivorship research should contribute to harmonizing these assets to identify effective interventions, maximize their reach and adoption, and integrate promising practices into routine care.
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Affiliation(s)
- Lori A Pollack
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Pratt-Chapman M, Simon MA, Patterson AK, Risendal BC, Patierno S. Survivorship navigation outcome measures: a report from the ACS patient navigation working group on survivorship navigation. Cancer 2011; 117:3575-84. [PMID: 21780092 DOI: 10.1002/cncr.26261] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Survivorship navigation is a relatively new concept in the field of patient navigation but an important one. This article highlights the essential functions of the survivorship navigator and defines core outcomes and measures for navigation in the survivorship period. Barriers to access to care experienced by patients during active cancer treatment can continue into the post-treatment period, affecting quality follow-up care for survivors. These barriers to care can be particularly acute for non-English speakers, immigrants, the uninsured, the underinsured, and other vulnerable populations. The survivorship navigator can help reduce barriers and facilitate access to survivorship care and services through communication and information exchange for patients. Survivorship navigation may improve appropriate health care utilization through education and care coordination, potentially improving health outcomes and quality of life of survivors while reducing cost to the health care system. Survivorship navigators can also educate survivors on how to improve their overall wellness, thereby directly impacting the health of a growing population of cancer survivors.
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Affiliation(s)
- Mandi Pratt-Chapman
- Division of Cancer Survivorship, The George Washington University Cancer Institute, 2300 Eye Street NW, Washington, DC 20037, USA
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25
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Rollison DE, Giuliano AR, Risendal BC, Sweeney C, Boulware D, Laronga C, Baumgartner KB, Byers T, Slattery ML. Serum insulin-like growth factor (IGF)-1 and IGF binding protein-3 in relation to breast cancer among Hispanic and white, non-Hispanic women in the US Southwest. Breast Cancer Res Treat 2009; 121:661-9. [PMID: 19888649 DOI: 10.1007/s10549-009-0609-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 10/15/2009] [Indexed: 12/22/2022]
Abstract
Insulin-like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) have been positively associated with breast cancer, especially among premenopausal women. Hispanic women have lower levels of IGF-1 and IGFBP-3 than non-Hispanic white (NHW) women, although no studies have adequately assessed the relationship among IGF-1, IGFBP-3, and breast cancer in Hispanic women. We investigated the association among IGF-1, IGFBP-3, and breast cancer within a subset of participants (n = 184 cases, 522 controls) of a population-based case-control study of women living in the U.S. Southwest. Serum levels of IGF-1 and IGFBP-3 were measured in fasting blood samples, and associations among IGF-1, IGFBP-3, and breast cancer were calculated using logistic regression, adjusting for age, study center, ethnicity, education, recent hormone exposure, body mass index, parity, total energy expenditure, total calories, and cholesterol. Both IGF-1 and IGFBP-3 were statistically significantly associated with breast cancer overall (highest vs. lowest quartile (Q4 vs. Q1) for IGF-1: odds ratio (OR) = 1.92, 95% confidence interval (CI) = 1.07-3.43); for IGFBP-3: OR = 3.04, 95% CI = 1.63-5.67). Positive associations were observed for both premenopausal breast cancer and postmenopausal breast cancer. IGF-1 was associated with breast cancer in NHW women (Q4 vs. Q1: OR = 2.82, 95% CI = 1.36-5.83), but not in Hispanic women (Q4 vs. Q1: OR = 0.81, 95% CI = 0.29-2.27). IGFBP-3 was associated with breast cancer in both ethnic groups (Q4 vs. Q1 for NHW: OR = 3.32, 95% CI = 1.45-7.60; Q4 vs. Q1 for Hispanics: OR = 2.15, 95% CI = 0.76-6.04). In conclusion, the association between IGF-1 and breast cancer differed by ethnicity, while no ethnic differences were observed in IGFBP-3-associated breast cancer.
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Affiliation(s)
- Dana E Rollison
- Division of Cancer Prevention and Control, H. Lee Moffitt Cancer Center and Research Institute, Magnolia Drive, Tampa, FL 33612, USA.
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