1
|
Graboyes EM, Lee SC, Lindau ST, Adams AS, Adjei BA, Brown M, Sadigh G, Incudine A, Carlos RC, Ramsey SD, Bangs R. Interventions addressing health-related social needs among patients with cancer. J Natl Cancer Inst 2024; 116:497-505. [PMID: 38175791 DOI: 10.1093/jnci/djad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
Health-related social needs are prevalent among cancer patients; associated with substantial negative health consequences; and drive pervasive inequities in cancer incidence, severity, treatment choices and decisions, and outcomes. To address the lack of clinical trial evidence to guide health-related social needs interventions among cancer patients, the National Cancer Institute Cancer Care Delivery Research Steering Committee convened experts to participate in a clinical trials planning meeting with the goal of designing studies to screen for and address health-related social needs among cancer patients. In this commentary, we discuss the rationale for, and challenges of, designing and testing health-related social needs interventions in alignment with the National Academy of Sciences, Engineering, and Medicine 5As framework. Evidence for food, housing, utilities, interpersonal safety, and transportation health-related social needs interventions is analyzed. Evidence regarding health-related social needs and delivery of health-related social needs interventions differs in maturity and applicability to cancer context, with transportation problems having the most maturity and interpersonal safety the least. We offer practical recommendations for health-related social needs interventions among cancer patients and the caregivers, families, and friends who support their health-related social needs. Cross-cutting (ie, health-related social needs agnostic) recommendations include leveraging navigation (eg, people, technology) to identify, refer, and deliver health-related social needs interventions; addressing health-related social needs through multilevel interventions; and recognizing that health-related social needs are states, not traits, that fluctuate over time. Health-related social needs-specific interventions are recommended, and pros and cons of addressing more than one health-related social needs concurrently are characterized. Considerations for collaborating with community partners are highlighted. The need for careful planning, strong partners, and funding is stressed. Finally, we outline a future research agenda to address evidence gaps.
Collapse
Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Cancer Center, University of Kansas, Kansas City, KS, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA
| | - Alyce S Adams
- Departments of Health Policy/Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Office of Cancer Health Equity and Community Engagement, Stanford Cancer Institute, Stanford Medicine, Stanford, CA, USA
| | - Brenda A Adjei
- Office of the Associate Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Mary Brown
- Adena Cancer Center, Hematology and Oncology, Chillicothe, OH, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
| | | | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Scott D Ramsey
- Department of Pharmacy, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Rick Bangs
- SWOG Cancer Research Network, Portland, OR, USA
| |
Collapse
|
2
|
Darby A, Cleveland Manchanda EC, Janeway H, Samra S, Hicks MN, Long R, Gipson KA, Chary AN, Adjei BA, Khanna K, Pierce A, Kaltiso SAO, Spadafore S, Tsai J, Dekker A, Thiessen ME, Foster J, Diaz R, Mizuno M, Schoenfeld E. Race, racism, and antiracism in emergency medicine: A scoping review of the literature and research agenda for the future. Acad Emerg Med 2022; 29:1383-1398. [PMID: 36200540 DOI: 10.1111/acem.14601] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objective was to conduct a scoping review of the literature and develop consensus-derived research priorities for future research inquiry in an effort to (1) identify and summarize existing research related to race, racism, and antiracism in emergency medicine (EM) and adjacent fields and (2) set the agenda for EM research in these topic areas. METHODS A scoping review of the literature using PubMed and EMBASE databases, as well as review of citations from included articles, formed the basis for discussions with community stakeholders, who in turn helped to inform and shape the discussion and recommendations of participants in the Society for Academic Emergency Medicine (SAEM) consensus conference. Through electronic surveys and two virtual meetings held in April 2021, consensus was reached on terminology, language, and priority research questions, which were rated on importance or impact (highest, medium, lower) and feasibility or ease of answering (easiest, moderate, difficult). RESULTS A total of 344 articles were identified through the literature search, of which 187 met inclusion criteria; an additional 34 were identified through citation review. Findings of racial inequities in EM and related fields were grouped in 28 topic areas, from which emerged 44 key research questions. A dearth of evidence for interventions to address manifestations of racism in EM was noted throughout. CONCLUSIONS Evidence of racism in EM emerged in nearly every facet of our literature. Key research priorities identified through consensus processes provide a roadmap for addressing and eliminating racism and other systems of oppression in EM.
Collapse
Affiliation(s)
- Anna Darby
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, California, USA
| | | | - Hannah Janeway
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Shamsher Samra
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Marquita Norman Hicks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ruby Long
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katrina A Gipson
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Brenda A Adjei
- National Cancer Institute Division of Cancer Control and Population Sciences, Bethesda, Maryland, USA
| | - Kajal Khanna
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ava Pierce
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sheri-Ann O Kaltiso
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sophia Spadafore
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Annette Dekker
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Molly E Thiessen
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Jordan Foster
- Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Rose Diaz
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Mikaela Mizuno
- University of California, Riverside School of Medicine, Riverside, California, USA
| | - Elizabeth Schoenfeld
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| |
Collapse
|
3
|
Bhattacharya M, Geiger AM, Castro KM, Adjei BA. Increasing research to address cancer care disparities in an NCI-sponsored community oncology network. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.176] [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
176 Background: Improving the delivery and outcomes of cancer care should be informed by research that aims to reduce disparities among underserved populations and those underrepresented in clinical studies. The NCI Community Oncology Research Program (NCORP), a community-based clinical trials network, conducts such research. In this analysis, we aimed to identify opportunities to develop a robust program of disparities-relevant cancer care delivery research (CCDR). Methods: We reviewed NCORP CCDR studies approved between August 2014-May 2022. Any study with at least one aim addressing care delivery in NIH-health disparity or underrepresented populations was deemed disparities-relevant. Studies were categorized as: primary if they were focused exclusively on cancer disparities within populations of interest; secondary if they had a disparities-related aim in a broader study; and exploratory if the aim assessed differences by race, ethnicity, income, insurance status, or practice-level characteristics. For each CCDR protocol, study and disparities-related characteristics were abstracted by two reviewers, who resolved any disagreements by discussion. Descriptive statistics are summarized. Results: Of 23 CCDR studies, a majority had at least one disparities-relevant aim: 4 primary, 3 secondary, and 10 exploratory. Studies with primary and secondary aims focused on racial/ethnic minorities, rural residents, older adults, adolescent/young adults and socioeconomically disadvantaged populations. Cancer care delivery gaps addressed by these studies included shared decision making, guideline adherence, case management, healthcare expenditures, and healthcare accessibility. Most studies focused on patients undergoing active treatment and included multilevel interventions. Only one of the disparities-relevant studies was available to non-English speaking patients. Conclusions: The inclusion of disparities-relevant aims in most of the care delivery studies is encouraging. The fact that most studies with a primary or secondary aim included an intervention demonstrates strong interest in generating evidence that will support improved cancer care delivery. Studies also addressed several distinct disparity populations across a range of care delivery gaps. These results represent opportunities for targeted network efforts to increase the disparities research portfolio and may inform strategies to optimize equitable care delivery that meets the needs of diverse cancer patient/survivor populations.
Collapse
|
4
|
Sanchez JI, Adjei BA, Randhawa G, Medel J, Doose M, Oh A, Jacobsen PB. National Cancer Institute-Funded Social Risk Research in Cancer Care Delivery: Opportunities for Future Research. J Natl Cancer Inst 2022; 114:1628-1635. [PMID: 36073952 PMCID: PMC9949593 DOI: 10.1093/jnci/djac171] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Cancer patients and survivors with food insecurity, housing instability, and transportation-related barriers face challenges in access and utilization of quality cancer care thereby adversely impacting their health outcomes. This portfolio analysis synthesized and described National Cancer Institute (NCI)-supported social risk research focused on assessing food insecurity, housing instability, and transportation-related barriers among individuals diagnosed with cancer. METHODS We conducted a query using the National Institutes of Health iSearch tool to identify NCI-awarded extramural research and training grants (2010-2022). Grant abstracts, specific aims, and research strategies were coded for research characteristics, study population, and outcomes. RESULTS Of the 30 grants included in this analysis, most assessed transportation-related barriers as patient-level social needs. Grants focused on community-level social risks, food insecurity, and housing instability were largely absent. Most grants included activities that identified the presence of social risks and/or needs (n = 24), connected patients to social care resources (n = 10), and engaged community members or organizations to inform the research study (n = 9). Of the grants, 18 focused on a single type of cancer, primarily breast cancer, and more than half focused on the treatment and survivorship phases. CONCLUSIONS In the last decade, there has been limited NCI-funded social risk research grants focused on food insecurity and housing instability. Findings highlight opportunities for future cancer care delivery research, including community and health system-level approaches that integrate social and clinical care to address social risks and social needs. Such efforts can help improve outcomes of populations that experience cancer health and health-care disparities.
Collapse
Affiliation(s)
- Janeth I Sanchez
- Correspondence to: Janeth I. Sanchez, PhD, MPH, National Cancer Institute, Medical Center Drive, Rockville, MD 20850, USA (e-mail: )
| | - Brenda A Adjei
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Gurvaneet Randhawa
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Josh Medel
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michelle Doose
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - April Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
5
|
Adjei BA, White DP, McCarthy S, Priede LM, Baker M, Kent EE, Weaver SJ, Geiger AM. Opportunities for Cancer Health Care Disparities and Care Delivery Research: An Analysis of the NCI Health Care Delivery Research Program Portfolio. J Health Care Poor Underserved 2021; 32:1475-1492. [PMID: 34421044 DOI: 10.1353/hpu.2021.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cancer health care disparities are complex, involve patient, clinician and health care system factors, and are defined as adverse differences in cancer outcomes. This analysis describes NCI's Healthcare Delivery Research Program's (HDRP) portfolio of disparities-focused research and identifies future research opportunities. Grants through HDRP (fiscal years 2012 to 2016) focused on detecting, understanding, and/or intervening on disparities in or among health disparity populations were reviewed by co-authors. Forty-eight funded grants were identified, coded, and characterized. Descriptive analyses are reported. Most studies focused on racial/ethnic minorities and socioeconomically disadvantaged groups. Colorectal, breast, and cervical cancers were most frequently examined. Almost 40% of studies addressed the intervening phase of the disparities research continuum. Few studies focused on clinician-level factors or involved the community in the research design. A sustained disparities research emphasis is essential to addressing the determinants of and cancer burden among health disparity populations across the cancer care continuum.
Collapse
|
6
|
Spain P, Teixeira-Poit S, Halpern MT, Castro K, Prabhu Das I, Adjei BA, Clauser S. NCI Community Cancer Center Program (NCCCP): Understanding why hormonal therapy for breast cancer was considered but not administered. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.74] [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
74 Background: The National Cancer Institute Community Cancer Centers Program (NCCCP) was designed to improve the quality of cancer care and reduce disparities at hospital-based community cancer centers. This study examined when guideline-concordant therapy was considered but not administered, who made the decision to not receive treatment. Methods: A retrospective analysis of patients diagnosed and receiving all or part of their initial cancer treatment at one of 12 NCCCP sites was conducted. We examined patients who were guideline-concordant with the hormonal therapy (HT) for breast cancer quality measure, but for whom treatment was considered but not administered. We compared patients diagnosed in the pre-NCCCP period (2006 – 2007) and during the NCCCP period (2008-2013). Results: Overall, a low proportion of cases had HT considered but not administered (4% in pre-NCCCP period; 5% in NCCCP period – difference not significant). In the pre-NCCCP period, white patients were twice as likely as Black patients to have HT considered but not administered, while there were no racial differences during the NCCCP period. In both time periods, older patients and Medicare patients were more likely to have HT considered but not administered. The most common reason for considering but not administering HT was refusal by the patient or patient’s family and this more likely for White patients, patients in the middle age groups (50-59 and 60 to 69), and Medicare patients. The second most common reason was that the physician determined it to be contraindicated due to patient risk factors. This was more likely to be a reason for Black and Medicaid patients. Conclusions: Results show that a large proportion of cases that had treatment considered but not administered did not receive treatment because of patient/family refusal or it was contraindicated due to other patient risk factors, both before and during the NCCCP period. Additional studies could inform the long-term outcomes of patients with comorbid conditions who were considered for guideline-concordant treatment but did not receive it (but the data were not available for this study).
Collapse
Affiliation(s)
| | | | | | - Kathleen Castro
- Division of Cancer Control and Population Science, National Cancer Institute of the National Institutes of Health, Bethesda, MD
| | - Irene Prabhu Das
- Division of Cancer Control and Population Science, National Cancer Institute of the National Institutes of Health, Rockville, MD
| | | | - Steven Clauser
- Patient-Centered Outcomes Research Institute, Washington, DC
| |
Collapse
|
7
|
Teixeira-Poit S, Spain P, Halpern MT, Castro KM, Prabhu Das I, Adjei BA, Clauser S. NCI Community Cancer Center Program (NCCCP): Disparities in time between cancer diagnosis and treatment initiation. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.279] [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
279 Background: The National Cancer Institute Community Cancer Centers Program (NCCCP) was designed to improve care and reduce cancer disparities at community hospitals. This study examined the number of days between diagnosis and treatment for five National Quality Forum-endorsed cancer quality measures. Methods: A retrospective analysis of data from patients diagnosed and receiving breast or colon cancer treatment at 12 NCCCP sites was performed. We examined time to treatment for cancer quality measures, stratified by concordant and non-concordant patients. We compared patients diagnosed before (2006 – 2007) vs. during (2008-2013) the NCCCP period. Results: Concordant Cases. Time to treatment was significantly greater in the NCCCP vs. pre-NCCCP periods for three measures. Compared to pre-the NCCCP period, time to treatment in the NCCCP period was longer by 26 days for women with breast cancer receiving hormonal therapy (HT). Time to HT increased significantly among most patient and hospital subgroups (race, age, insurance, hospital size). Black, Medicaid, and/or uninsured patients generally had longer-than-average time to treatment for all measures when receiving guideline-concordant care. Non-Concordant Cases. Among women with breast cancer who received treatment outside the measure window, most eligible for multi-agent chemotherapy received treatment within one month after the cut-off. In contrast, a majority eligible for other cancer quality measures received treatment more than one after the cut-off. Among women who were non-concordant for HT, those with Medicare or private insurance were significantly more likely to begin HT within one month after the cut-off than were those with Medicaid. Conclusions: More than half of patients non-concordant on cancer quality measures received treatment more than one month after the treatment window. However, many were non-concordant because they were just outside the time window to be considered concordant (< 30 days), particularly Medicaid patients. Rapid reporting of quality indicators could inform targeted efforts to improve care coordination and concordance rates, particularly among certain patient subgroups.
Collapse
Affiliation(s)
| | | | | | | | - Irene Prabhu Das
- Division of Cancer Control and Population Science, National Cancer Institute of the National Institutes of Health, Rockville, MD
| | | | - Steven Clauser
- Patient-Centered Outcomes Research Institute, Washington, DC
| |
Collapse
|
8
|
Castro KM, Spain P, Teixeira-Poit S, Prabhu Das I, Adjei BA, Siegel RD, Clauser S, Halpern MT. Sustaining quality cancer care in the NCI Community Cancer Centers Program (NCCCP). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6536] [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: 11/20/2022] Open
Affiliation(s)
- Kathleen M. Castro
- National Cancer Institute of the National Institutes of Health, Rockville, MD
| | | | | | - Irene Prabhu Das
- Division of Cancer Control and Population Science, National Cancer Institute of the National Institutes of Health, Rockville, MD
| | | | - Robert D. Siegel
- Hartford Hospital-Helen and Harry Gray Cancer Center, Hartford, CT
| | - Steven Clauser
- Patient Centered Outcomes Research Institute, Washington, DC
| | | |
Collapse
|
9
|
O'Brien DM, Bright MA, Clauser SB, Fennell M, Harness JK, Hood DD, Johnson M, Katurakes NC, McCaskill-Stevens W, Zapka J, Adjei BA, Castro KM, Dimond EP, St. Germain DC, Springfield S. The NCI Community Cancer Centers Program (NCCCP): A model for reducing cancer health care disparities. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.6086] [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
6086 Background: In 2007, NCI launched the NCCCP, a public-private partnership with 16 community hospital cancer centers in 14 states, to explore methods to improve patient access to advanced cancer care in the community. With 40% of its NCI funding directed to reduce disparities across the cancer continuum, the NCCCP aims to: 1) Enhance access to care; 2) Improve quality of care; and 3) Increase clinical trials accrual. This approach supports priorities in the 2009 ASCO Policy Statement: Disparities in Cancer Care. Methods: A disparities workplan was developed to support the three aims. NCI and the sites worked as a learning collaborative to develop strategies and metrics for: race and ethnicity data tracking; near real-time reporting of adherence to Commission on Cancer (CoC) treatment quality measures; community outreach and patient navigation to increase cancer screening; and improved clinical trial underserved accrual. The tools and resources supporting these efforts will be discussed. ( http://ncccp.cancer.gov/About/Progress.htm ). Results: Evaluation of the 3 year pilot shows improvement for underserved populations: Concordance with CoC treatment quality measures for radiation therapy for breast conserving surgery among Medicaid patients improved from 59.5 percent to 84.8 percent (p<.05). Increased community screening events (from 992 to 1,585) and community partnerships focused on underserved populations (from 78 to 195). Increased accrual to NCI trials (minority accrual from 82 to 151 and elderly from 200 to 641). Conclusions: To be effective in reducing healthcare disparities, a multi-level approach is needed. This includes having: organizations which demonstrate a strong community-oriented mission; commitment by hospital management; engagement of private practice physicians; targeted training of staff; use of standardized data collection and metrics; involvement of strategic partners with aligned goals at the national and local level; support by relevant NCI experts; and sharing best practices across a learning collaborative. The NCCCP disparities model was used in a variety of community settings targeting different underserved populations and has demonstrated effect in care in the respective communities.
Collapse
Affiliation(s)
| | | | | | | | - Jay K. Harness
- The Center for Cancer Prevention and Treatment, St. Joseph Hospital of Orange, Orange, CA
| | | | - Maureen Johnson
- NCI Office of the Director, Project Officer NCCCP, Bethesda, MD
| | | | | | - Jane Zapka
- Medical University of South Carolina, Charleston, SC
| | | | | | - Eileen P. Dimond
- National Cancer Institute, Division of Cancer Prevention, Bethesda, MD
| | | | | |
Collapse
|
10
|
Consedine NS, Adjei BA, Horton D, Joe AK, Borrell LN, Ramirez PM, Ungar T, McKiernan JM, Jacobson JS, Magai C, Neugut AI. Fear and loathing in the Caribbean: three studies of fear and cancer screening in Brooklyn's immigrant Caribbean subpopulations. Infect Agent Cancer 2009; 4 Suppl 1:S14. [PMID: 19208205 PMCID: PMC2638459 DOI: 10.1186/1750-9378-4-s1-s14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nathan S Consedine
- Department of Psychology, Long Island University, Brooklyn, NY 11201, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Consedine NS, Adjei BA, Ramirez PM, McKiernan JM. An object lesson: source determines the relations that trait anxiety, prostate cancer worry, and screening fear hold with prostate screening frequency. Cancer Epidemiol Biomarkers Prev 2008; 17:1631-9. [PMID: 18628414 DOI: 10.1158/1055-9965.epi-07-2538] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [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] [Indexed: 11/16/2022] Open
Abstract
Fears regarding prostate cancer and the associated screening are widespread. However, the relations between anxiety, cancer worry, and screening fear and screening behavior are complex, because anxieties stemming from different sources have different effects on behavior. In differentiating among anxieties from different sources (trait anxiety, cancer worry, and screening fear), we expected that cancer worry would be associated with more frequent screening, whereas fear of screening would be associated with less frequent screening. Hypotheses were tested in a sample of 533 men (ages 45-70 years) recruited using a stratified cluster-sampling plan. Men provided information on demographic and structural variables (age, education, income, marital status, physician discussion of risk and screening, access, and insurance) and completed a set of anxiety measures (trait anxiety, cancer worry, and screening fear). As expected, two-step multiple regressions controlling for demographics, health insurance status, physician discussion, and health-care system barriers showed that prostate-specific antigen and digital rectal examination frequencies had unique associations with cancer worry and screening fear. Specifically, whereas cancer worry was associated with more frequent screening, fear of screening was associated with less frequent screening at least for digital rectal examination; trait anxiety was inconsistently related to screening. Data are discussed in terms of their implications for male screening and the understanding of how anxiety motivates health behaviors. It is suggested that understanding the source of anxiety and the manner in which health behaviors such as cancer screenings may enhance or reduce felt anxiety is a likely key to understanding the associations between anxiety and behavioral outcomes.
Collapse
|
12
|
Magai C, Consedine NS, Adjei BA, Hershman D, Neugut A. Psychosocial influences on suboptimal adjuvant breast cancer treatment adherence among African American women: implications for education and intervention. Health Educ Behav 2007; 35:835-54. [PMID: 17909222 DOI: 10.1177/1090198107303281] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/15/2022]
Abstract
Despite lower incidence, African American women are at increased risk of dying from breast cancer relative to their European American counterparts. Although there are key differences in both screening behavior and tumor characteristics, an additional part of this mortality difference may lie in the fact that African American women receive suboptimal adjuvant chemotherapy and may receive suboptimal hormonal therapy, therapies that are known to increase survival. The authors consider ethnic differences in the psychosocial factors that have been shown to relate to poor screening adherence and consider how they may influence adherence to breast cancer adjuvant treatment, thus the receipt of suboptimal adjuvant chemo or hormonal therapy. To this end, they review ethnic differences in cognitive, emotional, and social network variables. Psychosocial variables should be included in research designed to understand cancer disparities as well interventions that can be tailored to culturally diverse populations to improve treatment adherence.
Collapse
Affiliation(s)
- Carol Magai
- Department of Psychology, Long Island University, Brooklyn, New York 11201, USA.
| | | | | | | | | |
Collapse
|