1
|
Desjardins MR, Kanarek NF, Nelson WG, Bachman J, Curriero FC. Disparities in Cancer Stage Outcomes by Catchment Areas for a Comprehensive Cancer Center. JAMA Netw Open 2024; 7:e249474. [PMID: 38696166 PMCID: PMC11066700 DOI: 10.1001/jamanetworkopen.2024.9474] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/04/2024] [Indexed: 05/05/2024] Open
Abstract
Importance The National Cancer Institute comprehensive cancer centers (CCCs) lack spatial and temporal evaluation of their self-designated catchment areas. Objective To identify disparities in cancer stage at diagnosis within and outside a CCC's catchment area across a 10-year period using spatial and statistical analyses. Design, Setting, and Participants This cross-sectional, population-based study conducted between 2010 and 2019 utilized cancer registry data for the Johns Hopkins Sidney Kimmel CCC (SKCCC). Eligible participants included patients with cancer in the contiguous US who received treatment for cancer, a diagnosis of cancer, or both at SKCCC. Patients were geocoded to zip code tabulation areas (ZCTAs). Individual-level variables included sociodemographic characteristics, smoking and alcohol use, treatment type, cancer site, and insurance type. Data analysis was performed between March and July 2023. Exposures Distance between SKCCC and ZCTAs were computed to generate a catchment area of the closest 75% of patients and outer zones in 5% increments for comparison. Main Outcomes and Measures The primary outcome was cancer stage at diagnosis, defined as early-stage, late-stage, or unknown stage. Multinomial logistic regression was used to determine associations of catchment area with stage at diagnosis. Results This study had a total of 94 007 participants (46 009 male [48.94%] and 47 998 female [51.06%]; 30 195 aged 22-45 years [32.12%]; 4209 Asian [4.48%]; 2408 Hispanic [2.56%]; 16 004 non-Hispanic Black [17.02%]; 69 052 non-Hispanic White [73.45%]; and 2334 with other or unknown race or ethnicity [2.48%]), including 47 245 patients (50.26%) who received a diagnosis of early-stage cancer, 19 491 (20.73%) who received a diagnosis of late-stage cancer , and 27 271 (29.01%) with unknown stage. Living outside the main catchment area was associated with higher odds of late-stage cancers for those who received only a diagnosis (odds ratio [OR], 1.50; 95% CI, 1.10-2.05) or only treatment (OR, 1.44; 95% CI, 1.28-1.61) at SKCCC. Non-Hispanic Black patients (OR, 1.16; 95% CI, 1.10-1.23) and those with Medicaid (OR, 1.65; 95% CI, 1.46-1.86) and no insurance at time of treatment (OR, 2.12; 95% CI, 1.79-2.51) also had higher odds of receiving a late-stage cancer diagnosis. Conclusions and Relevance In this cross-sectional study of CCC data from 2010 to 2019, patients residing outside the main catchment area, non-Hispanic Black patients, and patients with Medicaid or no insurance had higher odds of late-stage diagnoses. These findings suggest that disadvantaged populations and those living outside of the main catchment area of a CCC may face barriers to screening and treatment. Care-sharing agreements among CCCs could address these issues.
Collapse
Affiliation(s)
- Michael R. Desjardins
- Department of Epidemiology and Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Norma F. Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - William G. Nelson
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jamie Bachman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Frank C. Curriero
- Department of Epidemiology and Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
2
|
Galiatsatos P, Oluyinka M, Min J, Schreiber R, Lansey DG, Ikpe R, Pacheco MC, DeJaco V, Ellison-Barnes A, Neptune E, Kanarek NF, Cudjoe TKM. Prevalence of Mental Health and Social Connection among Patients Seeking Tobacco Dependence Management: A Pilot Study. Int J Environ Res Public Health 2022; 19:11755. [PMID: 36142029 PMCID: PMC9517384 DOI: 10.3390/ijerph191811755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION with regards to tobacco dependence management, there are certain barriers to successful smoking cessation for patients, such as untreated anxiety and depression. Complicating the impact of mental health morbidities on tobacco dependence may be the significant portion of patients whose mental health issues and limited social connections are undiagnosed and unaddressed. We hypothesize that patients with no prior mental health diagnoses who are treated for tobacco dependence have high rates of undiagnosed mental health morbidities. METHODS patients were recruited from a tobacco treatment clinic in 2021. Every patient who came for an inaugural visit without a prior diagnosis of mental health disease was screened for depression, anxiety, social isolation and loneliness. Sociodemographic variables were collected. RESULTS over a 12-month period, 114 patients were seen at the tobacco treatment clinic. Of these 114 patients, 77 (67.5%) did not have a prior diagnosis of a mental health disease. The mean age was 54.3 ± 11.2 years, 52 (67.5%) were females, and 64 (83.1%) were Black/African American. The mean age of starting smoking was 19.3 ± 5.2 years, and 43 (55.8%) had never attempted to quit smoking in the past. With regards to mental health screening, 32 (41.6%) patients had a score of 9 or greater on the Patient Health Questionnaire (PHQ) 9, 59 (76.6%) had a score of 7 or greater on the Generalized Anxiety Disorder (GAD) 7, 67 (87.0%) were identified with social isolation and 70 (90.1%) for loneliness on screening. CONCLUSION there was a high prevalence of undiagnosed mental health morbidities and social disconnection in patients who were actively smoking and were struggling to achieve smoking cessation. While a larger scale study is necessary to reaffirm these results, screening for mental health morbidities and social disconnection may be warranted in order to provide effective tobacco dependence management.
Collapse
Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
- Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - MopeninuJesu Oluyinka
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
- Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Jihyun Min
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
| | - Raiza Schreiber
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
| | - Dina G. Lansey
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Ruth Ikpe
- Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Manuel C. Pacheco
- Univeridad Tecnológica de Pereira, Universidad Visión de las Americas, Pereira 660003, Colombia
| | - Victoria DeJaco
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
| | | | - Enid Neptune
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- The Tobacco Treatment and Cancer Screening Clinic, Baltimore, MD 21224, USA
| | - Norma F. Kanarek
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Environmental Health and Engineering, Johns Hopkins School of Public Health, Baltimore, MD 21224, USA
| | - Thomas K. M. Cudjoe
- Medicine for the Greater Good, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| |
Collapse
|
3
|
Soori M, Platz EA, Brawley OW, Lawrence RS, Kanarek NF. Inclusion of the US Preventive Services Task Force Recommendation for Mammography in State Comprehensive Cancer Control Plans in the US. JAMA Netw Open 2022; 5:e229706. [PMID: 35499828 PMCID: PMC9062688 DOI: 10.1001/jamanetworkopen.2022.9706] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The recommendations for the age and frequency that women at average risk for breast cancer should undergo breast cancer mammography screening have been a matter of emotional, political, and scientific debate over the past decades. Multiple national organizations provide recommendations for breast cancer screening age and frequency. US Centers for Disease Control and Prevention (CDC) funding for state comprehensive cancer control (CCC) planning requires compliance with stated objectives for attaining goals. US Preventive Services Task Force (USPSTF) recommendations on cancer prevention and control are currently used to require coverage of prevention services. OBJECTIVES To evaluate the consistency of state CCC plan objectives compared with the most current (2016) USPSTF recommendations for the age and frequency that individuals should undergo mammography screening and to make recommendations for improvement of state CCC plans. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used a descriptive, point-in-time evaluation and was conducted from November 1, 2019, to June 30, 2021. In November 2019, the most recent CCC plans from 50 US states and the District of Columbia were downloaded from the CDC website. The recommended ages at which to begin and end mammography examinations and the frequency of mammography examinations were extracted from plan objectives. MAIN OUTCOMES AND MEASURES The recommendations found in CCC plan objectives regarding the ages at which to begin and end mammography examinations and the frequency of mammography examinations for women with average risk for breast cancer were compared with USPSTF recommendations. RESULTS Of the 51 CCC plans, 16 (31%) were consistent with all USPSTF recommendations for age and frequency that women at average risk should undergo mammography. Twenty-six plans (51%) were partially consistent with recommendations, and 9 plans (18%) were not consistent with any of the 3 guideline components. CONCLUSIONS AND RELEVANCE Compared with the USPSTF recommendation, state CCC plans are not homogenous regarding the age and frequency that women at average risk for breast cancer should undergo mammography. This variation is partially due to differences in state-specific planning considerations and discretion, variations in recommendations among national organizations, and publication of plans prior to the most current USPSTF recommendation (2016). Specifying the concept that high-risk populations need different age and frequency of screening recommendations than the general population may reduce heterogeneity among plans.
Collapse
Affiliation(s)
- Mehrnoosh Soori
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Otis W. Brawley
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Robert S. Lawrence
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Norma F. Kanarek
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
4
|
Phillips RL, Kanarek NF, Boothe VL. Rebuilding a US Federal Data Strategy After the End of the "Community Health Status Indicators". Am J Public Health 2021; 111:1865-1873. [PMID: 34623882 PMCID: PMC8561194 DOI: 10.2105/ajph.2021.306437] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/04/2022]
Abstract
For nearly 2 decades, the Community Health Status Indicators tool reliably supplied communities with standardized, local health data and the capacity for peer-community comparisons. At the same time, it created a large community of users who shared learning in addressing local health needs. The tool survived a transition from the Health Resources and Services Administration to the Centers for Disease Control and Prevention before being shuttered in 2017. While new community data tools have come online, nothing has replaced Community Health Status Indicators, and many stakeholders continue to clamor for something new that will enable local health needs assessments, peer comparisons, and creation of a community of solutions. The National Committee on Vital and Health Statistics heard from many stakeholders that they still need a replacement data source. (Am J Public Health. 2021;111(10):1865-1873. https://doi.org/10.2105/AJPH.2021.306437).
Collapse
Affiliation(s)
- Robert L Phillips
- Robert L. Phillips Jr is with The Center for Professionalism and Value in Health Care, Washington, DC, and the American Board of Family Medicine, Lexington, KY. Norma F. Kanarek is with the Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, and the Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD. Vickie L. Boothe is an environmental engineer and epidemiologist consultant and scientific advisor, New Orleans, LA
| | - Norma F Kanarek
- Robert L. Phillips Jr is with The Center for Professionalism and Value in Health Care, Washington, DC, and the American Board of Family Medicine, Lexington, KY. Norma F. Kanarek is with the Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, and the Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD. Vickie L. Boothe is an environmental engineer and epidemiologist consultant and scientific advisor, New Orleans, LA
| | - Vickie L Boothe
- Robert L. Phillips Jr is with The Center for Professionalism and Value in Health Care, Washington, DC, and the American Board of Family Medicine, Lexington, KY. Norma F. Kanarek is with the Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, and the Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD. Vickie L. Boothe is an environmental engineer and epidemiologist consultant and scientific advisor, New Orleans, LA
| |
Collapse
|
5
|
Yeh HC, Maruthur NM, Wang NY, Jerome GJ, Dalcin AT, Tseng E, White K, Miller ER, Juraschek SP, Mueller NT, Charleston J, Durkin N, Hassoon A, Lansey DG, Kanarek NF, Carducci MA, Appel LJ. Effects of Behavioral Weight Loss and Metformin on IGFs in Cancer Survivors: A Randomized Trial. J Clin Endocrinol Metab 2021; 106:e4179-e4191. [PMID: 33884414 PMCID: PMC8475239 DOI: 10.1210/clinem/dgab266] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 12/26/2022]
Abstract
CONTEXT Higher levels of insulin-like growth factor-1 (IGF-1) are associated with increased risk of cancers and higher mortality. Therapies that reduce IGF-1 have considerable appeal as means to prevent recurrence. DESIGN Randomized, 3-parallel-arm controlled clinical trial. INTERVENTIONS AND OUTCOMES Cancer survivors with overweight or obesity were randomized to (1) self-directed weight loss (comparison), (2) coach-directed weight loss, or (3) metformin treatment. Main outcomes were changes in IGF-1 and IGF-1:IGFBP3 molar ratio at 6 months. The trial duration was 12 months. RESULTS Of the 121 randomized participants, 79% were women, 46% were African Americans, and the mean age was 60 years. At baseline, the average body mass index was 35 kg/m2; mean IGF-1 was 72.9 (SD, 21.7) ng/mL; and mean IGF1:IGFBP3 molar ratio was 0.17 (SD, 0.05). At 6 months, weight changes were -1.0% (P = 0.07), -4.2% (P < 0.0001), and -2.8% (P < 0.0001) in self-directed, coach-directed, and metformin groups, respectively. Compared with the self-directed group, participants in metformin had significant decreases on IGF-1 (mean difference in change: -5.50 ng/mL, P = 0.02) and IGF1:IGFBP3 molar ratio (mean difference in change: -0.0119, P = 0.011) at 3 months. The significant decrease of IGF-1 remained in participants with obesity at 6 months (mean difference in change: -7.2 ng/mL; 95% CI: -13.3 to -1.1), but not in participants with overweight (P for interaction = 0.045). There were no significant differences in changes between the coach-directed and self-directed groups. There were no differences in outcomes at 12 months. CONCLUSIONS In cancer survivors with obesity, metformin may have a short-term effect on IGF-1 reduction that wanes over time.
Collapse
Affiliation(s)
- Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- Correspondence: Hsin-Chieh Yeh, PhD, Medicine, Epidemiology, and Oncology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, 2024 E. Monument St, Suite 2-500, Baltimore, MD 21205.
| | - Nisa M Maruthur
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Gerald J Jerome
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Kinesiology, Towson University, Towson, MD, USA
| | - Arlene T Dalcin
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Eva Tseng
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Karen White
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Stephen P Juraschek
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Noel T Mueller
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Jeanne Charleston
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Nowella Durkin
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ahmed Hassoon
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Dina G Lansey
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Norma F Kanarek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Michael A Carducci
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of International Health (Human Nutrition), Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
6
|
Slemp CC, Sisco S, Jean MC, Ahmed MS, Kanarek NF, Erös-Sarnyai M, Gonzalez IA, Igusa T, Lane K, Tirado FP, Tria M, Lin S, Martins VN, Ravi S, Kendra JM, Carbone EG, Links JM. Applying an Innovative Model of Disaster Resilience at the Neighborhood Level : The COPEWELL New York City Experience. Public Health Rep 2020; 135:565-570. [PMID: 32735159 DOI: 10.1177/0033354920938012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community resilience is a community's ability to maintain functioning (ie, delivery of services) during and after a disaster event. The Composite of Post-Event Well-Being (COPEWELL) is a system dynamics model of community resilience that predicts a community's disaster-specific functioning over time. We explored COPEWELL's usefulness as a practice-based tool for understanding community resilience and to engage partners in identifying resilience-strengthening strategies. In 2014, along with academic partners, the New York City Department of Health and Mental Hygiene organized an interdisciplinary work group that used COPEWELL to advance cross-sector engagement, design approaches to understand and strengthen community resilience, and identify local data to explore COPEWELL implementation at neighborhood levels. The authors conducted participant interviews and collected shared experiences to capture information on lessons learned. The COPEWELL model led to an improved understanding of community resilience among agency members and community partners. Integration and enhanced alignment of efforts among preparedness, disaster resilience, and community development emerged. The work group identified strategies to strengthen resilience. Searches of neighborhood-level data sets and mapping helped prioritize communities that are vulnerable to disasters (eg, medically vulnerable, socially isolated, low income). These actions increased understanding of available data, identified data gaps, and generated ideas for future data collection. The COPEWELL model can be used to drive an understanding of resilience, identify key geographic areas at risk during and after a disaster, spur efforts to build on local metrics, and result in innovative interventions that integrate and align efforts among emergency preparedness, community development, and broader public health initiatives.
Collapse
Affiliation(s)
- Catherine C Slemp
- 161119 Independent Consultant, Public Health Policy and Practice, Milton, WV, USA
| | - Sarah Sisco
- 2012 Office of Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Marc C Jean
- 2012 Office of Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene, New York, NY, USA.,Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Munerah S Ahmed
- 5939 Division of Environmental Health, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Norma F Kanarek
- 25802 Center for Public Health Preparedness, Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,1466 Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Monika Erös-Sarnyai
- 1466 Office of Community Resilience, Division of Mental Hygiene, Johns Hopkins University, Baltimore, MD, USA
| | - Ingrid A Gonzalez
- 2012 Office of Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Takeru Igusa
- 1466 Department of Civil Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn Lane
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fernando P Tirado
- 5939 Center for Health Equity, Bronx Neighborhood Health Action Center, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Maryellen Tria
- 5939 Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Sen Lin
- 1466 Department of Civil Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Valter N Martins
- 137755 Disaster Research Center, University of Delaware, Newark, DE, USA
| | - Sanjana Ravi
- 25802 Center for Health Security, Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - James M Kendra
- 137755 Disaster Research Center, University of Delaware, Newark, DE, USA
| | - Eric G Carbone
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan M Links
- 25802 Center for Public Health Preparedness, Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
7
|
Lansey DG, Hefka TA, Carducci MA, Kanarek NF. Problem Solving to Enhance Clinical Trial Participation Utilizing a Framework-Driven Approach. Clin Adv Hematol Oncol 2020; 18:468-476. [PMID: 32903246] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Health professionals agree that increasing diversity in clinical trial participants is an important way to improve cancer care and address disparities in outcomes. However, trial participation among minority populations has been low historically and continues to be low. Underrepresentation has resulted in majority groups reaping greater benefit from research findings, thus widening cancer health disparities. Addressing these disparities effectively has proven to be challenging. To maximize diversity among participants, it is necessary to understand the steps patients take to enroll in trials; the barriers patients face at each step; and the needs and preferences of the patient population overall and subgroups specified by age, race, ethnicity, or sex, in order to develop interventions to address barriers to participation. To improve clinical trial participation, and most importantly to eliminate disparities, cancer centers should examine reasons patients fail to enroll in trials and develop interventions designed to meet their patients' needs and preferences.
Collapse
Affiliation(s)
- Dina G Lansey
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Taylor A Hefka
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Michael A Carducci
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Norma F Kanarek
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, Maryland
| |
Collapse
|
8
|
Beyene DA, Kanarek NF, Naab TJ, Ricks-Santi LL, Hudson TS. Annexin 2 protein expression is associated with breast cancer subtypes in African American women. Heliyon 2020; 6:e03241. [PMID: 32072035 PMCID: PMC7011040 DOI: 10.1016/j.heliyon.2020.e03241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 09/18/2019] [Accepted: 01/14/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A review of literature on the expression of Annexin 2 in cancer has shown that there is very limited research work on the association of this protein with breast cancer aggressiveness in African Americans. In the present study, TMA breast tissues from African American women were stained with Annexin 2 antibody to determine the association between the molecular subtypes and Annexin 2 protein expression. METHOD An annotated case series of 135 breast cancer tissues archived from 2000 to 2010 was acquired from the Howard University Tumor Registry. The association between ANX2 expression and survival by molecular subtypes Luminal A, Luminal B, HER2, and Triple Negative (TN) was assessed using Multinomial regression, chi-square analysis, and Kaplan-Meir graphs (Stata 11). RESULTS Our findings show a marked association between ANX2 protein expression in Luminal B and HER2 subtypes unadjusted and when adjusted for age. Borderline differences in tumor grade were found in TN only.Univariately, age (<50, 50 + years) and metastases were highly significant for overall survival, disease-free survival and recurrence-free survival. Stage, tumor size, and nodal involvement were of borderline or greater significance for overall and disease-free survival. ANX2 expression was not significant. Kaplan Meier tests of ANX2 showed significant separation of overall survival by ANX2 protein expression in all breast tumor subtypes. In multivariate analyses comparing TN to Luminal A, ANX2 was not important while controlling for age and grade. CONCLUSION ANX2 might be a biomarker of aggressiveness and a relevant candidate biomarker in high risk African American women with Luminal B and HER2 breast cancer.
Collapse
Affiliation(s)
- Desta A. Beyene
- Department of Biochemistry and Molecular Biology, Howard University, Washington, DC, USA
- Department of Research, Veteran Affairs Medical Center, Washington, DC, USA
- Howard University Cancer Center, Washington, DC, USA
| | - Norma F. Kanarek
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health and Department of Oncology, Johns Hospital School of Medicine, USA
| | - Tammey J. Naab
- Department of Pathology, College of Medicine, Howard University, Washington, DC, USA
| | - Luisel L. Ricks-Santi
- Department of Biological Sciences, Cancer Research Center, Hampton University, Hampton, VA, USA
| | - Tamaro S. Hudson
- Department of Research, Veteran Affairs Medical Center, Washington, DC, USA
- Department of Pharmacology, College of Medicine, Howard University, Washington, DC, USA
- Howard University Cancer Center, Washington, DC, USA
| |
Collapse
|
9
|
Chadid S, Barber JR, Rohrmann S, Nelson WG, Yager JD, Kanarek NF, Bradwin G, Dobs AS, McGlynn KA, Platz EA. Age-Specific Serum Total and Free Estradiol Concentrations in Healthy Men in US Nationally Representative Samples. J Endocr Soc 2019; 3:1825-1836. [PMID: 31555753 PMCID: PMC6749840 DOI: 10.1210/js.2019-00178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/15/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose To report age-specific serum estradiol concentration in nonsmoking, lean US men without comorbidities. We provide concentrations from 30 and 15 to 20 years ago given previously described declines in serum estradiol in US men over time. Methods We used data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988 to 1991) and continuous NHANES (1999 to 2004). Serum estradiol and SHBG were previously measured by competitive electrochemiluminescence immunoassays. Free estradiol was estimated from estradiol, SHBG, and albumin. By age, we calculated median concentrations overall and for nonsmoking, lean (body mass index <25 kg/m2 and waist <102 cm) men without diabetes, cardiovascular disease, or cancer. Results Overall, respective total estradiol medians for men ages 20 to 39, 40 to 59, and ≥60 years old were 37.0, 33.9, and 33.5 pg/mL in NHANES III and 31.3, 30.5, and 27.0 pg/mL in continuous NHANES. In nonsmoking, lean men without comorbidities, respective total estradiol medians were 32.0, 32.1, and 32.0 pg/mL in NHANES III and 29.1, 22.7, and 26.1 pg/mL in continuous NHANES. Overall, respective free estradiol medians were 0.82, 0.72, and 0.64 pg/mL in NHANES III and 0.67, 0.61, and 0.47 pg/mL in continuous NHANES. In nonsmoking, lean men without comorbidities, respective free estradiol medians were 0.64, 0.67, and 0.62 pg/mL in NHANES III and 0.58, 0.42, and 0.40 pg/mL continuous NHANES. Conclusion We report US nationally representative serum estradiol concentrations in healthy men, which could be used for targeting estradiol during testosterone supplementation and for general good health.
Collapse
Affiliation(s)
- Susan Chadid
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John R Barber
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - William G Nelson
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Urology and the James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - James D Yager
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Norma F Kanarek
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gary Bradwin
- Department of Laboratory Medicine, Harvard Medical School and Children's Hospital, Boston, Massachusetts
| | - Adrian S Dobs
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
10
|
Platz EA, Barber JR, Chadid S, Lu J, Dobs AS, Kanarek NF, Nelson WG, Bradwin G, McGlynn KA, Rohrmann S. Nationally Representative Estimates of Serum Testosterone Concentration in Never-Smoking, Lean Men Without Aging-Associated Comorbidities. J Endocr Soc 2019; 3:1759-1770. [PMID: 31528824 PMCID: PMC6735742 DOI: 10.1210/js.2019-00151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/26/2019] [Indexed: 12/27/2022] Open
Abstract
Context Testosterone deficiency prevalence increases with age, comorbidities, and obesity. Objective To inform clinical guidelines for testosterone deficiency management and development of targets for nonpharmacologic intervention trials for these men, we determined serum testosterone in never-smoking, lean men without select comorbidities in nationally representative surveys. Design Setting Participants We used cross-sectional data for never-smoking, lean men ≥20 years without diabetes, myocardial infarction, congestive heart failure, stroke, or cancer, without use of hormone-influencing medications, and participated in morning sessions of National Health and Nutrition Examination Survey (NHANES) III (phase I 1988-1991) or continuous NHANES (1999-2004). By age, we determined median total testosterone (ng/mL) measured previously by a Food and Drug Administration-approved immunoassay and median estimated free testosterone concentration. Results In NHANES III, in never-smoking, lean men without comorbidities, median (25th, 75th percentile) testosterone was 4% to 9% higher than all men-20 to 39 years: 6.24 (5.16, 7.51), 40 to 59: 5.37 (3.83, 6.49), and ≥60: 4.61 (4.01, 5.18). In continuous NHANES, in never-smoking, lean men without comorbidities, levels were 13% to 24% higher than all men-20 to 39 years: 6.26 (5.32, 7.27), 40 to 59: 5.86 (4.91, 6.55), and ≥60: 4.22 (3.74, 5.73). In never-smoking, lean men without comorbidities, median estimated free testosterone was similar to (NHANES III) or slightly higher than (continuous NHANES) in all men. Conclusions These nationally representative data document testosterone levels (immunoassay) in never-smoking, lean men without select comorbidities 30 and 15 to 20 years ago. This information can be incorporated into guidelines for testosterone deficiency management and used to develop targets for nonpharmacologic intervention trials for testosterone deficiency.
Collapse
Affiliation(s)
- Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John R Barber
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Chadid
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jiayun Lu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adrian S Dobs
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Norma F Kanarek
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William G Nelson
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gary Bradwin
- Department of Laboratory Medicine, Harvard Medical School and Children's Hospital, Boston, Massachusetts
| | - Katherine A McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Bethesda, Maryland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Van Hemelrijck M, Sollie S, Nelson WG, Yager JD, Kanarek NF, Dobs A, Platz EA, Rohrmann S. Selenium and Sex Steroid Hormones in a U.S. Nationally Representative Sample of Men: A Role for the Link between Selenium and Estradiol in Prostate Carcinogenesis? Cancer Epidemiol Biomarkers Prev 2018; 28:578-583. [PMID: 30482876 DOI: 10.1158/1055-9965.epi-18-0520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/25/2018] [Accepted: 11/14/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Given the recent findings from pooled studies about a potential inverse association between selenium levels and prostate cancer risk, this cross-sectional study aimed to investigate the association between serum selenium and serum concentrations of sex steroid hormones including estradiol in a nationally representative sample of U.S. men to investigate one mechanism by which selenium may influence prostate cancer risk. METHODS The study included 1,420 men ages 20 years or older who participated in the Third National Health and Nutrition Examination Survey between 1988 and 1994. We calculated age/race-ethnicity-adjusted and multivariable-adjusted geometric mean serum concentrations of total and estimated free testosterone and estradiol, androstanediol glucuronide, and sex hormone binding globulin, and compared them across quartiles of serum selenium. RESULTS Adjusting for age, race/ethnicity, smoking status, serum cotinine, household income, physical activity, alcohol consumption, and percent body fat, mean total estradiol [e.g., Q1, 38.00 pg/mL (95% confidence interval (CI), 36.03-40.08) vs. Q4, 35.29 pg/mL (95% CI, 33.53-37.14); P trend = 0.050] and free estradiol [e.g., Q1, 0.96 pg/mL (95% CI, 0.92-1.01) vs. Q4, 0.90 (95% CI, 0.85-0.95); P trend = 0.065] concentrations decreased over quartiles of selenium. Stratification by smoking and alcohol consumption, showed that the latter observation was stronger for never smokers (P interaction = 0.073) and those with limited alcohol intake (P interaction = 0.017). No associations were observed for the other sex steroid hormones studied. CONCLUSIONS Our findings suggests that a possible mechanism by which selenium may be protective for prostate cancer is related to estrogen. IMPACT Further studies of longitudinal measurements of serum and toenail selenium in relation to serum measurements of sex steroid hormones are needed.
Collapse
Affiliation(s)
- Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, United Kingdom.
| | - Sam Sollie
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), London, United Kingdom
| | - William G Nelson
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James D Yager
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Norma F Kanarek
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adrian Dobs
- Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sabine Rohrmann
- Department of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
| |
Collapse
|
12
|
Beyene DA, Naab TJ, Kanarek NF, Apprey V, Esnakula A, Khan FA, Blackman MR, Brown CA, Hudson TS. Differential expression of Annexin 2, SPINK1, and Hsp60 predict progression of prostate cancer through bifurcated WHO Gleason score categories in African American men. Prostate 2018; 78:801-811. [PMID: 29682763 PMCID: PMC7257440 DOI: 10.1002/pros.23537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/27/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although studies have observed several markers correlate with progression of prostate cancer (PCa), no specific markers have been identified that accurately predict the progression of this disease, even in African American (AA) men who are generally at higher risk than other ethnic groups. The primary goal of this study was to explore whether three markers could predict the progression of PCa. METHOD We investigated protein expression of Annexin 2 (ANX2), serine peptidase inhibitor, kazal type 1(SPINK1)/tumor-associated trypsin inhibitor (TATI), and heat shock protein 60 (Hsp60) in 79 archival human prostate trans-rectal ultrasound (TRUS) biopsy tissues according to a modified World Health Organization (WHO) classification: normal (WHO1a), Gleason Score (GS6 (WHO1b), GS7 subgroups (WHO2 = 3 + 4, WHO3 = 4 + 3), GS8 (WHO4), and GS9-10 (WHO5). AA men aged 41-90 diagnosed from 1990 to 2013 at Howard University were included. Automated staining assessed expression of each biomarker. Spearman correlation assessed the direction and relationship between biomarkers, WHO and modified WHO GS, age, and 5-year survival. A two-tailed t-test and ANOVA evaluated biomarkers expression in relationship to WHO normal and other GS levels, and between WHO GS levels. A logistic and linear regression analysis examined the relationship between biomarker score and WHO GS categories. Kaplan-Meier curves graphed survival. RESULTS ANX2 expression decreased monotonically with the progression of PCa while expression of SPINK1/TATI and Hsp60 increased but had a more WHO GS-specific effect; SPINK1/TATI differed between normal and GS 2-6 and HSP60 differed between GS 7 and GS 2-6. WHO GS was found to be significantly and negatively associated with ANX2, and positively with SPINK1/TATI and Hsp60 expression. High SPINK1/TATI expression together with the low ANX2 expression at higher GS exhibited a bi-directional relationship that is associated with PCa progression and survival. CONCLUSION Importantly, the data reveal that ANX2, and SPINK1/TAT1 highly associate with WHO GS and with the transition from one stage of PrCa to the next in AA men. Future research is needed in biracial and larger population studies to confirm this dynamic relationship between ANX2 and SPINK1 as independent predictors of PCa progression in all men.
Collapse
Affiliation(s)
- Desta A Beyene
- Research Service, Veteran Affairs Medical Center, Washington, District of Columbia
- Howard University Cancer Center, Washington, District of Columbia
- Department of Biochemistry and Molecular Biology, Washington, District of Columbia
| | - Tammey J Naab
- Howard University Cancer Center, Washington, District of Columbia
- Department of Pathology, College of Medicine, Washington, District of Columbia
| | - Norma F Kanarek
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, and Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Victor Apprey
- National Human Genome Center, Howard University, Washington, District of Columbia
| | - Ashwini Esnakula
- Howard University Cancer Center, Washington, District of Columbia
- Department of Pathology, College of Medicine, Washington, District of Columbia
| | - Farahan A Khan
- Howard University Cancer Center, Washington, District of Columbia
- Department of Pathology, College of Medicine, Washington, District of Columbia
| | - Marc R Blackman
- Research Service, Veteran Affairs Medical Center, Washington, District of Columbia
| | - Collis A Brown
- Howard University Cancer Center, Washington, District of Columbia
- Department of Pharmacology, College of Medicine, Washington, District of Columbia
| | - Tamaro S Hudson
- Research Service, Veteran Affairs Medical Center, Washington, District of Columbia
- Howard University Cancer Center, Washington, District of Columbia
- Department of Pharmacology, College of Medicine, Washington, District of Columbia
| |
Collapse
|
13
|
Hardesty JJ, Kanarek NF. Barriers to non-small cell lung cancer trial eligibility. Contemp Clin Trials Commun 2018; 9:45-49. [PMID: 29696224 PMCID: PMC5898521 DOI: 10.1016/j.conctc.2017.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Cancer clinical trial (CCT) enrollment is low potentially threatening the generalizability of trial results and expedited regulatory approvals. We assessed whether type of initial patient appointment for non-small cell lung cancer (NSCLC) is associated with CCT eligibility. Methods Using a patient-to-accrual framework, we conducted a quasi-retrospective cohort pilot study at Sidney Kimmel Comprehensive Cancer Center (SKCCC), Baltimore, Maryland. 153 NSCLC patients new to SKCCC were categorized based on type of initial appointment: patients diagnosed or treated and patients seen for a consultation. CCT eligibility was determined by comparing eligibility criteria for each open trial to the electronic medical record (EMR) of each patient at every office visit occurring within 6-months of initial visit. Results We found no association between type of initial appointment and CCT eligibility (OR, 1.15; 95% CI, 0.49-2.73). Analyses did suggest current smokers were less likely to be eligible for trials compared to never smokers (OR, 0.15; 95% CI, 0.03-0.64), and stage 4 patients with second line therapy or greater were more likely to be eligible than stage 1 or 2 patients (OR, 5.18; 95% CI, 1.08-24.75). Additional analyses suggested most current smokers and stage 1 or 2 patients had trials available but were still ineligible. Conclusions SKCCC has a diverse portfolio of trials available for NSCLC patients and should consider research strategies to re-examine eligibility criteria for future trials to ensure increased enrollment of current smokers and stage 1 or 2 patients. We could not confirm whether type of initial visit was related to eligibility.
Collapse
Affiliation(s)
- Jeffrey J Hardesty
- Johns Hopkins University Bloomberg School of Public Health, USA.,Johns Hopkins University School of Medicine, Geriatrics Department, USA
| | - Norma F Kanarek
- Johns Hopkins University Bloomberg School of Public Health, USA.,Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, USA
| |
Collapse
|
14
|
Paller CJ, Cole AP, Partin AW, Carducci MA, Kanarek NF. Risk factors for metastatic prostate cancer: A sentinel event case series. Prostate 2017; 77:1366-1372. [PMID: 28786124 PMCID: PMC5621513 DOI: 10.1002/pros.23396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/17/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Root cause analysis is a technique used to assess systems factors related to "sentinel events"-serious adverse events within healthcare systems. This technique is commonly used to identify factors, which allowed these adverse events to occur, to target areas for improvement and to improve health care delivery systems. We sought to apply this technique to men presenting with metastatic prostate cancer (PCa). METHODS We performed an in-depth case series analysis of 15 patients, who presented with metastatic disease at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center using root cause analysis to refine a list of health system factors that lead to late stage presentation in the current era. RESULTS Key factors in late diagnosis of PCa included lack of insurance, lack of routine PSA testing, comorbidities, reticence of patients to follow up actionable PSA, and aggressive disease. Three patients had aggressive disease that would not have been discovered at an early stage in the disease process, despite routine screening. However, analysis of the remaining 12 patients illuminated health system factors led to missing important diagnostic information, which might have led to diagnosis of PCa at a curable stage. CONCLUSIONS The cases help highlight the need for systems based approaches to early diagnosis of PCa. A heterogeneous group of barriers to early diagnosis were identified in our series of patients including economic, health systems, and cultural factors. These findings underscore the need for individualized approaches to preventing delayed diagnosis of PCa. While limited by our single-institution scope, this approach provides a model for research and quality improvement initiatives to identify modifiable systems factors impeding appropriate diagnoses of PCa.
Collapse
Affiliation(s)
- Channing J. Paller
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Alexander P. Cole
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
| | - Alan W. Partin
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Michael A. Carducci
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Norma F. Kanarek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
15
|
Fowler SL, Platz EA, Diener-West M, Hokenmaier S, Truss M, Lewis C, Kanarek NF. Comparing the Maryland Comprehensive Cancer Control Plan With Federal Cancer Prevention and Control Recommendations. Prev Chronic Dis 2015; 12:E163. [PMID: 26425867 PMCID: PMC4591619 DOI: 10.5888/pcd12.150008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Since the introduction of the Affordable Care Act (ACA) in 2012, 11 million more Americans now have access to preventive services via health care coverage. Several prevention-related recommendations issued by the US Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), and Advisory Committee on Immunization Practices (ACIP) are covered under the ACA. State cancer plans often provide prevention strategies, but whether these strategies correspond to federal evidence-based recommendations is unclear. The objective of this article is to assess whether federal evidence-based recommendations, including those covered under the ACA, are included in the Maryland Comprehensive Cancer Control Plan (MCCCP). METHODS A total of 19 federal recommendations pertaining to cancer prevention and control were identified. Inclusion of federal cancer-related recommendations by USPSTF, CDC, and ACIP in the MCCCP's goals, objectives, and strategies was examined. RESULTS Nine of the federal recommendations were issued after the MCCCP's publication. MCCCP recommendations corresponded completely with 4 federal recommendations and corresponded only partially with 3. Reasons for partial correspondence included specification of less restrictive at-risk populations or different intervention implementers. Three federal recommendations were not mentioned in the MCCCP's goals, objectives, and strategies. CONCLUSION Many cancer-related federal recommendations were released after the MCCCP's publication and therefore do not appear in the most current version. We recommend that the results of this analysis be considered in the update of the MCCCP. Our findings underscore the need for a periodic scan for changes to federal recommendations and for adjusting state policies and programs to correspond with federal recommendations, as appropriate for Marylanders.
Collapse
Affiliation(s)
- Stephanie L Fowler
- National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, RM 3E-542, Bethesda, MD 20892-9712.
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Marie Diener-West
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Hokenmaier
- Maryland Department of Health and Mental Hygiene, Center for Cancer Prevention and Control, Baltimore, Maryland
| | - Meredith Truss
- Maryland Department of Health and Mental Hygiene, Center for Cancer Prevention and Control, Baltimore, Maryland
| | - Courtney Lewis
- Maryland Department of Health and Mental Hygiene, Center for Cancer Prevention and Control, Baltimore, Maryland
| | - Norma F Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| |
Collapse
|
16
|
Donaldson EA, Cohen JE, Truant PL, Rutkow L, Kanarek NF, Barry CL. News Media Framing of New York City's Sugar-Sweetened Beverage Portion-Size Cap. Am J Public Health 2015; 105:2202-9. [PMID: 26378853 DOI: 10.2105/ajph.2015.302673] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed news media framing of New York City's proposed regulation to prohibit the sale of sugar-sweetened beverages greater than 16 ounces. METHODS We conducted a quantitative content analysis of print and television news from within and outside New York City media markets. We examined support for and opposition to the portion-size cap in the news coverage from its May 31, 2012, proposal through the appellate court ruling on July 31, 2013. RESULTS News coverage corresponded to key events in the policy's evolution. Although most stories mentioned obesity as a problem, a larger proportion used opposing frames (84%) than pro-policy frames (36%). Mention of pro-policy frames shifted toward the policy's effect on special populations. The debate's most prominent frame was the opposing frame that the policy was beyond the government's role (69%). CONCLUSIONS News coverage within and outside the New York City media market was more likely to mention arguments in opposition to than in support of the portion-size cap. Understanding how the news media framed this issue provides important insights for advocates interested in advancing similar measures in other jurisdictions.
Collapse
Affiliation(s)
- Elisabeth A Donaldson
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Joanna E Cohen
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Patricia L Truant
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Lainie Rutkow
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Norma F Kanarek
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| | - Colleen L Barry
- Elisabeth A. Donaldson is a PhD candidate with the Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Joanna E. Cohen is with the Department of Health, Behavior and Society, and the Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University. Patricia L. Truant, Lainie Rutkow, and Colleen L. Barry are with the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University. Norma F. Kanarek is with the Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University
| |
Collapse
|
17
|
Paller CJ, Kanaan YM, Beyene DA, Naab TJ, Copeland RL, Tsai HL, Kanarek NF, Hudson TS. Risk of prostate cancer in African-American men: Evidence of mixed effects of dietary quercetin by serum vitamin D status. Prostate 2015; 75:1376-83. [PMID: 26047130 PMCID: PMC4536082 DOI: 10.1002/pros.23018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/22/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND African-American (AA) men experience higher rates of prostate cancer (PCa) and vitamin D (vitD) deficiency than white men. VitD is promoted for PCa prevention, but there is conflicting data on the association between vitD and PCa. We examined the association between serum vitD and dietary quercetin and their interaction with PCa risk in AA men. METHODS Participants included 90 AA men with PCa undergoing treatment at Howard University Hospital (HUH) and 62 controls participating in HUH's free PCa screening program. We measured serum 25-hydroxy vitD [25(OH)D] and used the 98.2 item Block Brief 2000 Food Frequency Questionnaires to measure dietary intake of quercetin and other nutrients. Case and control groups were compared using a two-sample t-test for continuous risk factors and a Fisher exact test for categorical factors. Associations between risk factors and PCa risk were examined via age-adjusted logistic regression models. RESULTS Interaction effects of dietary quercetin and serum vitD on PCa status were observed. AA men (age 40-70) with normal levels of serum vitD (>30 ng/ml) had a 71% lower risk of PCa compared to AA men with vitD deficiency (OR = 0.29, 95%CI: 0.08-1.03; P = 0.055). In individuals with vitD deficiency, increased dietary quercetin showed a tendency toward lower risk of PCa (OR = 0.91, 95%CI: 0.82-1.00; P = 0.054, age-adjusted) while men with normal vitD were at elevated risk (OR = 1.23, 95%CI: 1.04-1.45). CONCLUSION These findings suggest that AA men who are at a higher risk of PCa may benefit more from vitD intake, and supplementation with dietary quercetin may increase the risk of PCa in AA men with normal vitD levels. Further studies with larger populations are needed to better understand the impact of the interaction between sera vitD levels and supplementation with quercetin on PCa in AA men.
Collapse
Affiliation(s)
- C J Paller
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Y M Kanaan
- Department of Microbiology, Howard University Cancer Center, Washington, District of Columbia
| | - D A Beyene
- Department of Microbiology, Howard University Cancer Center, Washington, District of Columbia
| | - T J Naab
- Department of Pathology, Howard University Cancer Center, Washington, District of Columbia
| | - R L Copeland
- Department of Pharmacology, Howard University Cancer Center, Washington, District of Columbia
| | - H L Tsai
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Division of Biostatistics and Bioinformatics, Baltimore, Maryland
| | - N F Kanarek
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - T S Hudson
- Department of Pharmacology, Howard University Cancer Center, Washington, District of Columbia
| |
Collapse
|
18
|
Jones MR, Joshu CE, Kanarek NF, Navas-Acien A, Richardson KA, Platz EA. Abstract 3718: Trends in tobacco use and prostate cancer mortality in four US states, 1999-2010. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-3718] [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: 11/16/2022]
Abstract
Abstract
Background: In the US, prostate cancer mortality rates have declined in past decades. Cigarette smoking, a risk factor for prostate cancer death, has also declined. It is unknown whether declines in smoking prevalence produced detectable declines in prostate cancer mortality in the population.
Objective: To examine prostate cancer mortality rates in relation to changes in tobacco use in the population.
Methods: We studied men ≥35 years of age from California, Kentucky, Maryland and Utah. State smoking prevalences were obtained from the Behavioral Risk Factor Surveillance System (BRFSS). Mortality rates for prostate cancer and external causes, as a control condition, were obtained from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) system. The average annual percent change for smoking and prostate cancer mortality for 1999 to 2010 was estimated using joinpoint analysis.
Results: In 1999, the smoking prevalence among men ≥35 years of age was 31.7%, 20.9%, 19.9% and 14.8% in Kentucky, Maryland, California and Utah, respectively. Between 1999 and 2010, smoking in Kentucky declined by 3.0% per year (95% CI: -4.0%, -1.9%) and prostate cancer mortality declined by 3.5% per year (95% CI: -4.3%, -2.7%). In Maryland, smoking declined non-significantly by 3.0% per year (95% CI: -7.0%, 1.2%) and prostate cancer mortality declined by 3.5% per year (95% CI: -4.1%, -3.0%). In California, smoking declined by 3.5% per year (95% CI: -4.4%, -2.5%) and prostate cancer mortality declined by 2.5% per year (95% CI: -2.9%, -2.2%). In Utah, smoking declined by 3.5% per year (95% CI: -5.6%, -1.3%) and prostate cancer mortality declined by 2.1% per year (95% CI: -3.8%, -0.4%). No such patterns were observed for smoking and external causes of death in any of the states.
Conclusion: Similar declines were observed in the prevalence of smoking and prostate cancer mortality. Although ecological, this study suggests that declines in prostate cancer mortality rates are consistent with a beneficial effect of reducing tobacco use at the population level.
Citation Format: Miranda R. Jones, Corinne E. Joshu, Norma F. Kanarek, Ana Navas-Acien, Kelly A. Richardson, Elizabeth A. Platz. Trends in tobacco use and prostate cancer mortality in four US states, 1999-2010. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3718. doi:10.1158/1538-7445.AM2015-3718
Collapse
Affiliation(s)
| | | | | | - Ana Navas-Acien
- 1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | |
Collapse
|
19
|
Donaldson EA, Cohen JE, Villanti AC, Kanarek NF, Barry CL, Rutkow L. Patterns and predictors of state adult obesity prevention legislation enactment in US states: 2010-2013. Prev Med 2015; 74:117-22. [PMID: 25735604 PMCID: PMC4422336 DOI: 10.1016/j.ypmed.2015.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/20/2015] [Accepted: 02/21/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study examined bill- and state-level factors associated with enactment of adult obesity prevention legislation in US states. METHODS A review of bills in the Rudd Center for Food Policy and Obesity's legislative database identified 487 adult obesity prevention bills, or proposed legislation, introduced between 2010 and 2013. Multilevel models were constructed to examine bill- and state-level characteristics associated with enactment. RESULTS From 2010 to 2013, 81 (17%) of obesity prevention bills introduced were enacted across 35 states and the District of Columbia. Bills introduced in 2010 were more likely to be enacted than in 2013 (OR=9.49; 95% CI: 2.61-34.5). Bills focused on access to healthy food, physical activity, general and educational programs, as well as modifying rules and procedures (e.g., preemption) had greater odds of enactment relative to food and beverage taxes (OR=8.18; 95% CI: 2.85-23.4 healthy food; OR=17.3; 95% CI: 4.55-65.7 physical activity; OR=15.2; 95% CI: 4.80-47.9 general; OR=13.7; 95% CI: 3.07-61.5 rules). CONCLUSION The year of bill introduction and overall bill enactment rate were related to adult obesity prevention legislation enactment in states. This study highlights the importance of a bill's topic area for enactment and provides insights for advocates and policymakers trying to address enactment barriers.
Collapse
Affiliation(s)
- Elisabeth A Donaldson
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, United States.
| | - Joanna E Cohen
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, United States; Institute for Global Tobacco Control, Baltimore, MD, United States
| | - Andrea C Villanti
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, United States; Schroeder Institute for Tobacco Research and Policy Studies, Washington, DC, United States
| | - Norma F Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Colleen L Barry
- Department of Health, Policy, & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lainie Rutkow
- Department of Health, Policy, & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
20
|
Mathieu LN, Kanarek NF, Tsai HL, Rudin CM, Brock MV. Age and sex differences in the incidence of esophageal adenocarcinoma: results from the Surveillance, Epidemiology, and End Results (SEER) Registry (1973-2008). Dis Esophagus 2014; 27:757-63. [PMID: 24118313 PMCID: PMC3979505 DOI: 10.1111/dote.12147] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Risk factors driving sex disparity in esophageal cancer are unclear. Recent molecular evidence suggests hormonal factors. We conducted a national descriptive epidemiological study to assess the hypothesis that estrogen exposure could explain the male predominance in observed esophageal adenocarcinoma incidence. We analyzed the esophageal cancer incidence trends by histology and sex from 1973 to 2008 in nine population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) 9 Registry Database. We used age as a proxy for estrogen exposure in females. The collective age groups annual percentage change in esophageal adenocarcinoma for females is positive (0.03%; 95% confidence interval: 0.02, 0.03%) during the study period. Interestingly, the esophageal adenocarcinoma annual percentage change in incidence rates for females during the same time period is significantly negative from ages 50-54 to ages 60-64. Even though the incidence of esophageal adenocarcinoma rises in both males and females, the male-to-female ratio across age peaks in the 50-54 years then decreases. Furthermore, the esophageal adenocarcinoma age-adjusted incidence rate in postmenopausal females age 80 and above increases with age unlike their male counterparts. Taken together, these data support the hypothesis that the endocrine milieu in pre- and perimenopausal females serves as a protective factor against esophageal adenocarcinoma, and with loss of estrogen or because of the increasing time period away from estrogen exposure, the rate of esophageal adenocarcinoma incidence increases in the older postmenopausal female. Because females comprise the largest portion of the elderly population with esophageal adenocarcinoma, these findings are significant.
Collapse
Affiliation(s)
- Luckson N. Mathieu
- Johns Hopkins University School of Medicine, Department of Oncology, 410 North Broadway, Baltimore, MD 21231
| | - Norma F. Kanarek
- Johns Hopkins University School of Medicine, Department of Oncology, 410 North Broadway, Baltimore, MD 21231,Johns Hopkins University Bloomberg School of Public Health, Department of Environmental Health Sciences, 615 North Wolfe Street, Baltimore, MD 21205
| | - Hua-Ling Tsai
- Johns Hopkins University School of Medicine, Department of Oncology, 410 North Broadway, Baltimore, MD 21231
| | - Charles M. Rudin
- Johns Hopkins University School of Medicine, Department of Oncology, 410 North Broadway, Baltimore, MD 21231
| | - Malcolm V. Brock
- Johns Hopkins University School of Medicine, Department of Surgery, Bunting Blaustein Cancer Research Building, 1650 Orleans Street, Baltimore MD 21231
| |
Collapse
|
21
|
Kanarek NF, Hooker CM, Mathieu L, Tsai HL, Rudin CM, Herman JG, Brock MV. Survival after community diagnosis of early-stage non-small cell lung cancer. Am J Med 2014; 127:443-9. [PMID: 24486286 PMCID: PMC4601577 DOI: 10.1016/j.amjmed.2013.12.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 12/10/2013] [Accepted: 12/20/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND "Rush to surgery" among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease in study populations have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer. Our objective was to assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early-stage non-small cell lung cancer. METHODS Patients with early-stage lung cancer (N = 174) at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins who were diagnosed and treated from 2003 to 2009 and followed through 2011 made up a prospective study of overall survival. Diagnosis to first surgery interval was examined overall, as 2 segments (referral interval and treatment interval), as short and longer intervals, and as a continuous variable. RESULTS The majority of patients were female (55%) and aged more than 65 years (61%). The average mean referral and treatment delays were 61.2 and 5.9 days, respectively. Cox method hazard analysis revealed that older age (years) at diagnosis (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.05), stage IIB (HR, 2.17; 95% CI, 1.12-4.21), large (>4 cm) (HR, 3.68; 95% CI, 1.05-12.93) or unknown tumor size (HR, 4.45; 95% CI, 1.21-16.38), and weeks from diagnosis to first surgery interval (HR, 1.04; 95% CI, 1.00-1.09) predicted worse overall survival. The threshold period of less than 42 days from diagnosis to surgery did not reach statistical significance. CONCLUSIONS Patients seem to benefit from rapid reduction of tumor burden with surgery. Reasons for delay were not available. Nevertheless, referral delay experienced in the community is unduly long. In addition to patient choices, an unconscious patient or physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating and needs further investigation.
Collapse
Affiliation(s)
- Norma F Kanarek
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Craig M Hooker
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Luckson Mathieu
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Hua-Ling Tsai
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Charles M Rudin
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - James G Herman
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Malcolm V Brock
- Department of Surgery, Johns Hopkins University School of Medicine, Bunting Blaustein Cancer Research Building, Baltimore, Md
| |
Collapse
|
22
|
Kanarek NF, Kanarek MS, Olatoye D, Carducci MA. Removing barriers to participation in clinical trials, a conceptual framework and retrospective chart review study. Trials 2012; 13:237. [PMID: 23227880 PMCID: PMC3551829 DOI: 10.1186/1745-6215-13-237] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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: 09/18/2012] [Accepted: 11/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enrollment in interventional therapeutic clinical trials is a small fraction of all patients who might participate given reasonable access. METHODS A hierarchical approach is utilized in measuring staged participation from trial availability to patient enrollment. Our framework suggests that concern for justice comes in the design and eligibility criteria for clinical trials; attention to beneficence is given in the eligibility and physician triage stages. The remaining four stages rely on respect for persons. An example is given where reasons for nonparticipation or barriers to participation in prostate cancer clinical trials are examined within the framework. In addition, medical oncology patients with an initial six month consultation are tracked from one stage to the next by race using the framework to assess participation comparability. RESULTS We illustrated seven transitions from being a patient to enrollment in a clinical trial in a small study of prostate cancer cases who consulted SKCCC Medical Oncology Department in early 2010. Pilot data suggest transition probabilities as follows: 65% availability, 84% eligibility, 92% patient triage, 89% trials discussed, 45% patient interested, 63% patient consented, and 92% patient enrolled. The average transition probability was 77.7%. The average transition probability, patient-trial-fit was 50%; opportunity was 51%, and acceptance was 66.7%. Trial availability, patient interest and patient consented were three transitions that were below the average; none were statistically significant. CONCLUSIONS The framework may serve to streamline comprehensive reporting of clinical trial participation to the benefit of patients and the ethical conduct of clinical trials.
Collapse
Affiliation(s)
- Norma F Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|
23
|
Bischoff CM, Kanarek NF. Abstract A01: No Maryland county left behind: Statewide intervention may reduce geographic disparities. Cancer Epidemiol Biomarkers Prev 2012. [DOI: 10.1158/1055-9965.disp12-a01] [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: 11/16/2022] Open
Abstract
Abstract
Introduction: Recent Maryland cancer planning, funding and consensus building efforts and prior screening for breast and cervical cancer have successfully reduced mortality rates and racial disparities over time. Nevertheless geographical disparities among Maryland counties have not been examined.
To date assessment of racial disparities has been accomplished using the Index of Disparity. To evaluate geographic disparities and whether every county is improving regardless of its size we suggest utilization of coefficient of variation (CV), skewness and kurtosis. We investigated geographic disparities in county cancer mortality over three time periods and between Maryland and the five adjacent states.
Methods: Using data from CDC WONDER, we assessed county breast (female), colon/rectal, lung, and prostate (male) cancer mortality coefficient of variation, skewness, and kurtosis relative to a priori critical values.
Results: Maryland counties showed a coefficient of variation consistent with adjacent state counties. In both geographic areas, breast and colon/rectum coefficients of variation were statistically below 0.25. Skewness among Maryland counties was not significant in any time period or any site except prostate cancer, significantly positive (1.36, 95% confidence intervals: 0.43-2.29) only during 1994-98. Only the adjacent state counties exhibited statistically significant skewness and kurtosis for each cancer site at some time. Coefficient of variation is most often slightly smaller than the Index of Disparity due to the larger average of county rates relative to the overall rate (weighted by county).
Conclusion: With statewide funding since 1990, Maryland has eliminated geographic disparities in breast and colon/rectum cancer but continues to exhibit borderline lung/bronchus and significant prostate disparities exhibited by “large” coefficient of variation but not – skewness and kurtosis in 2004-2008. We suggest that absence of skewness and kurtosis may be a further indication of county disparities reduction.
Tracking of disparities across counties indicated whether statewide or county-specific interventions was needed and whether progress toward elimination of disparities was made. The ideal progression of geographic disparities is indicated by a resultant very small coefficient of variation; left, if any skewness; and no kurtosis. Maryland is on track to accomplish this in all four cancer mortality indicators and on target for breast and colon and rectum.
Citation Format: Christina M. Bischoff, Norma F. Kanarek. No Maryland county left behind: Statewide intervention may reduce geographic disparities. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A01.
Collapse
|
24
|
Kanarek NF, Kanarek M, Olatoye D, Carducci M. Abstract B74: Behavioral and social science: Recruitment/retention/adherence research. Cancer Epidemiol Biomarkers Prev 2012. [DOI: 10.1158/1055-9965.disp12-b74] [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: 11/16/2022] Open
Abstract
Abstract
Background: Enrollment in interventional therapeutic clinical trials is a small fraction of all patients who might participate given reasonable access. A case series of new prostate cancer cases are evaluated for their participation in a clinical trial.
Methods: A hierarchical approach is utilized in measuring staged participation from trial availability to patient enrollment. Our framework suggests that concern for justice comes in the design and eligibility criteria for clinical trials; attention to beneficence is given in the eligibility and physician triage stages. The remaining four stages (doctor discussion with the patient, patient interest, patient consent, patient enrolled) rely on respect for persons.
Reasons for nonparticipation or barriers to participation in prostate cancer clinical trials are examined within the seven step framework. Ninety-seven medical oncology patients with an initial six month consultation are tracked from one stage to the next to assess comparability of participation by race.
Results: We illustrated seven transitions from being a patient to enrollment in a clinical trial in a case series of prostate cancer cases who consulted medical oncology in early 2010 (n=97). Pilot data suggest transition probabilities as follows for patients 65% had trial availability, of those 84% were eligible, of those 92% were triaged, of those 100% have trials discussion, of those 51% were interested, of those 71% consented, and of those 94% enrolled. The average transition probability was 77.7%. Trial availability, patient interest and patient consented were three transitions that were below average; none were statistically significant however. We combined steps to obtain the probability of a patient-trial-fit, 50%; the probability of opportunity, 51%; and the probability of acceptance, 66.7%. there were no differences in enrollments by race.
Conclusions: The framework may serve to streamline comprehensive and improved reporting of clinical trial participation to the benefit of patients and toward the ethical conduct of clinical trials. The seven step framework may aid trouble shooting of flagging trial enrollment.
Citation Format: Norma F. Kanarek, Marty Kanarek, Dare Olatoye, Michael Carducci. Behavioral and social science: Recruitment/retention/adherence research. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B74.
Collapse
|
25
|
Kanarek NF, Hooker CM, Mathieu L, Tsai HL, Rudin CM, Herman JG, Brock MV. Abstract B78: Referral delay after community diagnosis of non-small cell lung cancer impairs survival. Cancer Epidemiol Biomarkers Prev 2012. [DOI: 10.1158/1055-9965.disp12-b78] [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: 11/16/2022] Open
Abstract
Abstract
Context: “Rush to surgery” among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer (NSCLC).
Objective: To assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early stage NSCLC.
Methods: Patients (N=174) diagnosed between 2003 and 2009 and treated at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins were followed for vital status through 2011.
Diagnosis to first surgery interval was examined overall; as two segments: referral interval and treatment interval; as short and longer intervals (<22, <31, and <43 days); and as a continuous variable. Our primary end point was survival since first surgery.
Results: Cox method hazard analysis revealed older age at diagnosis (OR=1.02 per year 95% confidence intervals:1.00-1.05), stage IIB (OR=2.17, 95% confidence intervals:1.12-4.21), large, >4 cm (OR=3.68, 95% confidence intervals: 1.05-12.93) or unknown tumor size (OR+4.45, 95% confidence intervals: 1.21-16.38), and longer length of diagnosis to first surgery interval predicted worse survival (OR= 1.04 per week delay, 95% confidence intervals: 1.00-1.09). Factors of race, place of residence, marital status, morbidity and insurance coverage were not predictive of survival or interval length. No threshold effect of time to surgery was observed.
Conclusions: Surgery is not only the best treatment for early stage NSCLC but it is urgent once a diagnosis is made. Patients benefit from universal consideration of lung cancer as a time sensitive condition that merits rapid response to reduce tumor burden, especially among patients with small tumors. We will need to know more about referral delays encountered by patients, because particularly small tumors found upon low dose computed tomography scan will increase. Referral delay experienced in the community is unduly long (61 days). In addition to patient choices, an unconscious physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating.
Citation Format: Norma F. Kanarek, Craig M. Hooker, Luckson Mathieu, Hua-Ling Tsai, Charles M. Rudin, James G. Herman, Malcolm V. Brock. Referral delay after community diagnosis of non-small cell lung cancer impairs survival. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B78.
Collapse
|
26
|
Levinson KL, Bristow RE, Donohue PK, Kanarek NF, Trimble CL. Impact of payer status on treatment of cervical cancer at a tertiary referral center. Gynecol Oncol 2011; 122:324-7. [PMID: 21620446 DOI: 10.1016/j.ygyno.2011.04.038] [Citation(s) in RCA: 5] [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] [Received: 02/28/2011] [Revised: 04/20/2011] [Accepted: 04/25/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study aims to determine the impact of payer status on the likelihood of receiving definitive treatment for invasive cervical cancer at a tertiary medical center. METHODS All consecutive patients presenting to Johns Hopkins Hospital with a diagnosis of invasive cervical cancer between 1/1/95-12/31/08 were retrospectively identified from the tumor registry. Demographic and clinical information were abstracted from the medical record. Payer status was categorized as private, public, no insurance, or unknown. Treatment was defined as surgery, chemo-radiation, chemotherapy, radiation, or no definitive therapy. The likelihood of receiving no definitive therapy was analyzed using Pearson chi-square analysis, univariate and multivariate models. RESULTS A total of 306 patients were identified. Median age was 47 and 60% of patients had early stage disease at diagnosis (stages IA-IIA). Fifty-six percent of the cohort had private insurance, 34% had public insurance, and 6% had no insurance. Having no insurance was the single most significant risk factor associated with receiving no standard therapy. While 7% of privately insured and 4% of publicly insured patients did not receive definitive therapy, 16% of uninsured patients did not receive definitive treatment. In multivariate analysis controlling for age, race, stage, histology, and comorbidities, uninsured payer status was a significant and independent predictor of receiving no definitive treatment (OR 8.01, CI 1.265-50.694, p=0.027) than patients with public insurance. CONCLUSIONS In this study, uninsured payer status was significantly associated with a higher likelihood of not receiving standard therapy for cervical cancer. Additional studies are warranted to characterize specific barriers to care for this at-risk population.
Collapse
Affiliation(s)
- Kimberly L Levinson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | | | | | |
Collapse
|
27
|
Kanarek NF, Tsai HL, Metzger-Gaud S, Damron D, Guseynova A, Klamerus JF, Rudin CM. Geographic Proximity and Racial Disparities in Cancer Clinical Trial Participation. J Natl Compr Canc Netw 2010; 8:1343-51. [DOI: 10.6004/jnccn.2010.0102] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
28
|
Weitzman JB, Kanarek NF, Smialek JE. Medical examiner asthma death autopsies: a distinct subgroup of asthma deaths with implications for public health preventive strategies. Arch Pathol Lab Med 1998; 122:691-9. [PMID: 9701330] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Asthma deaths have been increasing in the United States and worldwide. We studied medical examiner asthma death autopsy (MEADA) records for the state of Maryland, compared selected characteristics with state and national total asthma deaths (TADs), and comprehensively reviewed relevant literature to define characteristics of asthma deaths and to provide insight for the design of future preventive strategies directed at this subgroup. DESIGN Protocols for autopsy and clinical data. SETTING The Office of the Chief Medical Examiner of the State of Maryland. SUBJECTS All MEADAs in the state of Maryland from 1988 through 1992. MAIN OUTCOME MEASURES Descriptive analysis. RESULTS Maryland MEADAs (63 cases) represented 16.62% of Maryland TADs (379 cases). Most common characteristics of individuals on whom autopsies were performed: inner-city residence; single; black male; 15 to 54 years old; history of asthma; no other significant medical condition; fatal episode more likely to begin at home; pronounced dead at hospital; time of death between midnight and 6 AM; no particular seasonality; and typical gross and/or microscopic pathology. Analysis also revealed that 17.46% of deceased asthma patients had a history of drug abuse; 12.69% had positive toxicology for drugs of abuse; 9.52% were infants and young children up to 4 years old, all of whom were found, unresponsive, at home; and white females comprised the highest number of TADs but the lowest number of MEADAs. CONCLUSION Asthma education programs focused on asthmatic inner-city black males, especially those with a history of drug abuse, and on parents of inner-city asthmatic infants and children may be a useful preventive strategy. International, national, and regional MEADA databases may also be of use in the design and monitoring of preventive strategies directed at this subgroup.
Collapse
Affiliation(s)
- J B Weitzman
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
| | | | | |
Collapse
|
29
|
Popoli G, Sobelman S, Kanarek NF. Suicide in the State of Maryland, 1970-80. Public Health Rep 1989; 104:298-301. [PMID: 2498981 PMCID: PMC1579926] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A univariate and multivariate analysis of factors associated with suicide for residents of the State of Maryland was conducted. The investigation was statistically oriented in its approach, examining the relationships of age, race, sex, marital status, and month of death with suicide. Besides the usual death rates, percentages, and age-specific rates, a discriminant analysis was performed to test this approach. Data were obtained on all suicides of Maryland residents, regardless of where the deaths occurred. Univariate analysis showed that the relationships between suicide and age, race, sex, and marital status are consistent with those in the literature. No significant relationship appeared to exist between the month of death and suicide. During multivariate analysis, the discriminant function correctly predicted 80 percent of all the deaths, 74 percent of suicides, and 80 percent of all other causes, in their respective categories.
Collapse
Affiliation(s)
- G Popoli
- Maryland Department of Health and Mental Health, Baltimore 21201
| | | | | |
Collapse
|