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Sutton AL, Felix AS, Wahl S, Franco RL, Leicht Z, Williams KP, Hundley WG, Sheppard VB. Racial disparities in treatment-related cardiovascular toxicities amongst women with breast cancer: a scoping review. J Cancer Surviv 2023; 17:1596-1605. [PMID: 35420375 DOI: 10.1007/s11764-022-01210-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Black women often experience poorer breast cancer-related outcomes and higher mortality than white women. A contributor to this disparity may relate to the disproportionate burden of cancer treatment-related cardiovascular (CV) toxicities. The objective of this review is to identify studies that report racial differences in CV toxicity risk. METHODS Medline and Embase were searched for studies that assessed CV toxicities as the outcome(s) and included Black and White women with breast cancer. Studies were selected based on inclusion/exclusion criteria and through the use of multiple reviewers. RESULTS The review included 13 studies following a review of 409 citations and 49 full-text articles. All studies were retrospective and 8/13 utilized data from the Surveillance, Epidemiology, and End Results-Medicare linked database. Trastuzumab was the most frequently studied treatment. The proportion of Black women in these studies ranged from 5.5 to 63%. A majority of studies reported a higher risk of CV toxicity amongst Black women when compared to white women (93%). Black women had up to a two times higher risk of CV toxicity (HR, 2.73 (CI, 1.24 to 6.01)) compared to white women. Only one study evaluated the role of socioeconomic factors in explaining racial differences in CV toxicity; however, the disparity remained even after adjusting for these factors. CONCLUSIONS There is a critical need for more longitudinal studies that evaluate multilevel factors (e.g., psychosocial, biological) that may help to explain this disparity. IMPLICATIONS FOR CANCER SURVIVORS Black cancer survivors may require additional surveillance and mitigation strategies to decrease disproportionate burden of CV toxicities.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA.
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Stacey Wahl
- Health Sciences Library, Virginia Commonwealth University, Richmond, VA, USA
| | - R Lee Franco
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Zachary Leicht
- Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesvile, VA, USA
| | | | - W Gregory Hundley
- Pauley Heart Center, Virginia Commonwealth University Health Sciences, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA
- Office of Health Equity and Disparities Research, Massey Cancer Center, Richmond, VA, USA
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Mandelblatt JS, Schechter CB, Stout NK, Huang H, Stein S, Hunter Chapman C, Trentham-Dietz A, Jayasekera J, Gangnon RE, Hampton JM, Abraham L, O’Meara ES, Sheppard VB, Lee SJ. Population simulation modeling of disparities in US breast cancer mortality. J Natl Cancer Inst Monogr 2023; 2023:178-187. [PMID: 37947337 PMCID: PMC10637022 DOI: 10.1093/jncimonographs/lgad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Populations of African American or Black women have persistently higher breast cancer mortality than the overall US population, despite having slightly lower age-adjusted incidence. METHODS Three Cancer Intervention and Surveillance Modeling Network simulation teams modeled cancer mortality disparities between Black female populations and the overall US population. Model inputs used racial group-specific data from clinical trials, national registries, nationally representative surveys, and observational studies. Analyses began with cancer mortality in the overall population and sequentially replaced parameters for Black populations to quantify the percentage of modeled breast cancer morality disparities attributable to differences in demographics, incidence, access to screening and treatment, and variation in tumor biology and response to therapy. RESULTS Results were similar across the 3 models. In 2019, racial differences in incidence and competing mortality accounted for a net ‒1% of mortality disparities, while tumor subtype and stage distributions accounted for a mean of 20% (range across models = 13%-24%), and screening accounted for a mean of 3% (range = 3%-4%) of the modeled mortality disparities. Treatment parameters accounted for the majority of modeled mortality disparities: mean = 17% (range = 16%-19%) for treatment initiation and mean = 61% (range = 57%-63%) for real-world effectiveness. CONCLUSION Our model results suggest that changes in policies that target improvements in treatment access could increase breast cancer equity. The findings also highlight that efforts must extend beyond policies targeting equity in treatment initiation to include high-quality treatment completion. This research will facilitate future modeling to test the effects of different specific policy changes on mortality disparities.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program at Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Clyde B Schechter
- Departments of Family and Social Medicine and of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Natasha K Stout
- Department of Population Sciences, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Hui Huang
- Department of Data Science, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Sarah Stein
- Department of Population Sciences, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Christina Hunter Chapman
- Department of Radiation Oncology, Section of Health Services Research, Baylor College of Medicine and Health Policy, Quality and Informatics Program at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Lab, National Institute on Minority Health and Health Disparities, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Ronald E Gangnon
- Departments of Population Health Sciences and of Biostatistics and Medical Informatics and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Ellen S O’Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Sandra J Lee
- Department of Data Science, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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Bowen A, Gómez-Trillos S, Curran G, Graves KD, Sheppard VB, Schwartz MD, Peshkin BN, Campos C, Garcés N, Dash C, Aburto L, Valencia-Rojas N, Hernández G, Villa A, Cupertino P, Carrera P, Hurtado-de-Mendoza A. Advancing health equity: A qualitative study assessing barriers and facilitators of implementing hereditary breast and ovarian cancer risk screening tools in community-based organizations. J Genet Couns 2023; 32:965-981. [PMID: 37062905 PMCID: PMC10577152 DOI: 10.1002/jgc4.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
Genetic counseling and testing (GCT) inform cancer management for persons at risk for hereditary breast and ovarian cancer (HBOC). Community-based organizations (CBOs) may play a role in identifying at-risk Latinx individuals to connect them to GCT but data are lacking. Two academic centers and their four CBO partners planned to implement a validated questionnaire for HBOC risk screening ("HBOC risk screening tool"). This study aimed to assess CBO's preferences for HBOC risk screening tools, as well as the barriers and facilitators anticipated for future implementation. Pre-implementation focus groups were conducted with CBO's staff. Discussions centered on current practices to identify and refer at-risk patients. During the discussion, staff were asked to select one out of five validated HBOC risk screening tools to implement and to discuss anticipated barriers/facilitators for implementation. The four focus groups were coded and qualitative analyzed following the Consolidated Framework for Implementation Research (CFIR) and Health Equity domains. All CBOs chose the Family History Screen 7 (FHS-7). Participants (N = 35) highlighted how the FHS-7 was easy to adapt to better fit the target population and changing guidelines. They had positive attitudes toward implementing the screening tool, stressed how the culture of the organization positioned them to reach the target population, and noted barriers in different CFIR domains (e.g., low knowledge about HBOC and GCT referrals; scarce available resources). Participants pointed to barriers related to health equity domains including limited access to GCT and follow-up care for uninsured and underinsured populations, challenges obtaining accurate family history, and immigration-related barriers. CBOs highlighted the importance of partnering with other stakeholders to overcome barriers. Findings emphasize the need to develop multi-level implementation strategies to overcome barriers and leverage facilitators. This study can inform the development of implementation toolkits for CBOs to implement HBOC screening tools to advance health equity.
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Affiliation(s)
| | - Sara Gómez-Trillos
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kristi D. Graves
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | | | - Marc D. Schwartz
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | - Beth N. Peshkin
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
| | | | - Nathaly Garcés
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Chiranjeev Dash
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | | | | | - Antonio Villa
- Virginia Commonwealth University, Richmond, Virginia, USA
- La Casa de la Salud, Richmond, Virginia, USA
| | - Paula Cupertino
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Alejandra Hurtado-de-Mendoza
- Georgetown University Medical Center, Washington, District of Columbia, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics Research, Washington, District of Columbia, USA
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Lucas AR, Kim Y, Lanoye A, Franco RL, Sutton AL, LaRose JG, Ross M, Sheppard VB. Longitudinal associations among physical activity and sitting with endocrine symptoms and quality of life in breast cancer survivors: A latent growth curve analysis. Cancer Med 2023; 12:20094-20105. [PMID: 37768040 PMCID: PMC10587924 DOI: 10.1002/cam4.6581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE Adjuvant endocrine therapy (AET) often causes debilitating endocrine symptoms that compromise quality of life (QOL) in women diagnosed with hormone receptor positive breast cancer (BC). We examined whether greater levels of physical activity (PA) or prolonged sitting were associated with reduced side effects or worse side effects of AET, respectively. METHODS We used parallel process latent growth curve models to examine longitudinal patterns in PA and sitting behaviors, and their association with endocrine symptoms and QOL over 3 years of follow-up in 554 female BC survivors undergoing AET. RESULTS At baseline, women were a mean age of 59 years, mostly white (72%), with overweight/obesity (67%), and approximately 50% were within 1 year of diagnosis. Unconditional models showed significant increases in PA (p < 0.01) over time but no change in sitting. Endocrine symptoms, general and BC-specific QOL all significantly worsened over time (p < 0.01). Parallel process models showed no cross-sectional or longitudinal associations between PA and endocrine symptoms. Higher levels of baseline PA were associated with higher baseline QOL scores (p = 0.01) but changes in PA were not associated with changes in QOL. Conversely, more sitting at baseline was associated with worse endocrine symptoms, general and BC specific QOL (ps <0.01). At baseline, having better QOL scores was associated with increases in sitting (ps <0.01), while having worse endocrine symptoms was associated with a slower rate of increase in sitting (p < 0.01). Increases in sitting time were also associated with a slower rate of increase in endocrine symptoms (p = 0.017). Model fit statistics (x2, CFI, TLI, SRMR) were acceptable. CONCLUSION Both PA and sitting behaviors are important for the management of symptoms and in maintaining QOL in BC survivors. Women with already high symptom burden do not increase sitting time further but having better general and BC specific QOL to begin with means a greater decline over time.
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Affiliation(s)
- Alexander R. Lucas
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of Internal Medicine – CardiologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Youngdeok Kim
- Department of Kinesiology and Health SciencesVirginia Commonwealth University College of Humanities and SciencesRichmondVirginiaUSA
| | - Autumn Lanoye
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - R. Lee Franco
- Department of Kinesiology and Health SciencesVirginia Commonwealth University College of Humanities and SciencesRichmondVirginiaUSA
| | - Arnethea L. Sutton
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Jessica G. LaRose
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Masey Ross
- Department of Internal Medicine‐ OncologyVirginia Commonwealth University Health SystemRichmondVirginiaUSA
| | - Vanessa B. Sheppard
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
- Office of Health Equity and Disparities Research, Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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Williams KP, Lin CJ, Felix AS, Addison D, Sheppard VB, Sutton AL, Mumma MT, Im W, Juarez PD, Hood DB. The association between cardiovascular disease and breast and gynecologic cancers among black female patients. J Natl Med Assoc 2023; 115:466-474. [PMID: 37558599 DOI: 10.1016/j.jnma.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/01/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Little is known about whether a breast or gynecologic cancer diagnosis increases long-term cardiovascular disease (CVD) risk among Black females. The purpose of this study was to determine whether a breast or gynecologic cancer diagnosis is associated with CVD risk and identify determinants of subsequent CVD risk among Black females with an incident breast or gynecologic cancer diagnosis. METHODS Using the Southern Community Cohort Study data from 2002-2016, this study was designed to analyze CVD incidence among Black females without cancer or CVD at enrollment. Cox proportional hazards regression models with or without covariates were used to explore the relationship between a breast or gynecologic cancer diagnosis and CVD risk among women without cancer as well as without CVD at enrollment (N=11,486). In addition, Cox proportional hazards regression models, excluding those who developed CVD before breast and gynecologic cancer diagnosis and those with other types of cancers, were used to assess determinants of CVD risk among breast and gynecologic cancer survivors. RESULTS Of 11,486 Black females, 531 developed a breast or gynecological cancer (4.6%) over a median follow-up of 140 months (interquartile range: 123-159 months). Compared to women without cancer, women with a breast or gynecological cancers had greater than 20% higher risk of incident CVD during the follow-up period. Without adjusting for covariates, positive association between CVD risk and breast cancer was observed (hazard ratio (HR) = 1.24; 95% confidence interval (CI) = 1.11 - 1.39; p < 0.001); as well as between CVD risk and a gynecological cancer (HR = 1.23; 95% CI = 1.03 - 1.46; p = 0.021). Yet, after adjusting for covariates, CVD risk was only significantly associated with breast cancer (p = 0.001) but not gynecologic cancer. In cancer case-only analyses, CVD risk was significantly increasing with age (p < 0.05). CONCLUSIONS Like study populations of predominantly White females, our results suggest that, adjusting for covariates, Black females possess a higher risk of CVD following a breast cancer diagnosis compared to women who did not develop breast cancer. Our results suggest a need for active CVD surveillance in the cancer survivorship phase.
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Affiliation(s)
- Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, United States.
| | - Chyongchiou J Lin
- Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, United States
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, V.B. Sheppard and A.L. Sutton, Virginia Commonwealth University, Richmond, VA, United States
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, School of Medicine, V.B. Sheppard and A.L. Sutton, Virginia Commonwealth University, Richmond, VA, United States
| | - Michael T Mumma
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, United States
| | - Paul D Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, United States
| | - Darryl B Hood
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, Ohio, United States
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Arezo S, Naavaal S, Garrett C, Wright MS, Sheppard VB, Preston MA. Implementation of a Cancer Education Program in Rural Counties with the Lowest HPV Vaccination Rates and Health Rankings. J Health Res 2023; 38:88-93. [PMID: 37869728 PMCID: PMC10588440 DOI: 10.56808/2586-940x.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Background Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). To address STIs, one rural county public school district developed a series of Family Life Programs to educate pre-teens about pertinent health information. The Schooling Cancer Program (SCP) was developed in partnership with the local Cancer Research and Resource Center to raise awareness about cancer risk factors including HPV-related cancers and HPV prevention methods. Methods We collected a post-evaluation survey from students who attended a SCP session at one of the targeted middle schools. The SCP educated students about topics focusing on healthy lifestyles. The survey asked students' knowledge on the SCP topics, HPV knowledge, tobacco usage, and factors that reduced cancer development. Results 87% agreed that tobacco products are associated with cancer, and 81% did not agree that E-cigarettes are scientifically proven to be safer than cigarettes. Although we do not have pre-evaluation data about these students' HPV knowledge, our evaluation survey shows that 80% of students correctly identified HPV as the most common STI, and 84% of students correctly identified the factors that decrease their risk of developing cancer. Conclusion Through this initiative, students learned essential health concepts and HPV-related risk factors.
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Affiliation(s)
- Sarah Arezo
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
| | - Shillpa Naavaal
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, School of Dentistry, Department of Dental Public Health and Policy, 520 North 12th Street, PO Box 980566, Richmond, VA 23298-0566, USA
| | - Charlotte Garrett
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, Massey Cancer Center, Health Equity & Disparities Research, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
| | - Marcie S. Wright
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, School of Medicine, Center on Health Disparities, 730 E. Broad St. 4th Floor, Richmond, VA 23219, USA
| | - Vanessa B. Sheppard
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, Massey Cancer Center, Health Equity & Disparities Research, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
| | - Michael A. Preston
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
- Virginia Commonwealth University, Massey Cancer Center, Health Equity & Disparities Research, 830 East Main Street, PO Box 980149, Richmond, VA 23298-0149, USA
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7
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Salgado TM, Radwan RM, Hickey Zacholski E, Mackler E, Buffington TM, Musselman KT, Irvin WJ, Perkins JM, Le TN, Dixon DL, Farris KB, Sheppard VB, Jones RM. Oncologists' responsibility, comfort, and knowledge managing hyperglycemia in patients with cancer undergoing chemotherapy: a cross sectional study. Support Care Cancer 2023; 31:450. [PMID: 37421495 DOI: 10.1007/s00520-023-07927-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To assess oncologists' responsibility, comfort, and knowledge managing hyperglycemia in patients undergoing chemotherapy. METHODS In this cross-sectional study, a questionnaire collected oncologists' perceptions about professionals responsible for managing hyperglycemia during chemotherapy; comfort (score range 12-120); and knowledge (score range 0-16). Descriptive statistics were calculated including Student t-tests and one-way ANOVA for mean score differences. Multivariable linear regression identified predictors of comfort and knowledge scores. RESULTS Respondents (N = 229) were 67.7% men, 91.3% White and mean age 52.1 years. Oncologists perceived endocrinologists/diabetologists and primary care physicians as those responsible for managing hyperglycemia during chemotherapy, and most frequently referred to these clinicians. Reasons for referral included lack of time to manage hyperglycemia (62.4%), belief that patients would benefit from referral to an alternative provider clinician (54.1%), and not perceiving hyperglycemia management in their scope of practice (52.4%). The top-3 barriers to patient referral were long wait times for primary care (69.9%) and endocrinology (68.1%) visits, and patient's provider outside of the oncologist's institution (52.8%). The top-3 barriers to treating hyperglycemia were lack of knowledge about when to start insulin, how to adjust insulin, and what insulin type works best. Women (ß = 1.67, 95% CI: 0.16, 3.18) and oncologists in suburban areas (ß = 6.98, 95% CI: 2.53, 11.44) had higher comfort scores than their respective counterparts; oncologists working in practices with > 10 oncologists had lower comfort scores (ß = -2.75, 95% CI: -4.96, -0.53) than those in practices with ≤ 10. No significant predictors were identified for knowledge. CONCLUSION Oncologists expected endocrinology or primary care clinicians to manage hyperglycemia during chemotherapy, but long wait times were among the top barriers cited when referring patients. New models that provide prompt and coordinated care are needed.
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Affiliation(s)
- Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, and Massey Cancer Center, Virginia Commonwealth University, PO Box 98053, 410 N. 12th Street, Richmond, VA, 23298, USA.
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA.
| | - Rotana M Radwan
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Erin Hickey Zacholski
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Emily Mackler
- Michigan Oncology Quality Consortium (MOQC) and Michigan Institute for Care Management and Transformation (MICMT), 4251 Plymouth Road Arbor Lakes, Building 3, Floor 3, Ann Arbor, MI, 48105, USA
| | - Tonya M Buffington
- Bon Secours Mercy Health, 611 Watkins Centre Parkway, Suite 250, Midlothian, Richmond, VA, 23114, USA
| | - Kerri T Musselman
- Emcara Health and PopHealthCare, 113 Seaboard Lane, Suite B200, Franklin, TN, 37067, USA
| | - William J Irvin
- Bon Secours Cancer Institute, Bon Secours Mercy Health, 14051 St Francis Blvd Suite 2210, Midlothian, VA, 23114, United States
| | - Jennifer M Perkins
- Division of Endocrinology, University of California San Francisco Medical Center, Endocrinology Clinic at Parnassus 400 Parnassus Ave., Suite A-550, San Francisco, CA, 94143, USA
| | - Trang N Le
- Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, 1101 E. Marshall St. Sanger Hall Suite 1-030, Richmond, VA, 23298, USA
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, PO Box 980533, 410 N. 12th Street, Richmond, VA, 23298, USA
| | - Karen B Farris
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Population Health, and Massey Comprehensive Cancer Center, Virginia Commonwealth University, 830 East Main Street, Richmond, VA, 23219, USA
| | - Resa M Jones
- Department of Epidemiology & Biostatistics, College of Public Health, and Fox Chase Cancer Center, Temple University, 1301 Cecil B. Moore Avenue Ritter Annex, 9th Floor, Suite 917, Philadelphia, PA, 19122, USA
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8
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Guidry JPD, Miller CA, Perrin PB, Carlyle KE, Savage MW, Sheppard VB, Fuemmeler BF. Pandemic coping and COVID-19 preventive behaviors among cancer survivors. Patient Educ Couns 2023; 112:107716. [PMID: 37004503 PMCID: PMC10035797 DOI: 10.1016/j.pec.2023.107716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Cancer survivors are at greater risk for COVID-19 complications, emphasizing the importance of adherence to COVID-19 prevention. Active coping mechanisms can help manage pandemic stress but disengaged coping practices can have adverse effects. OBJECTIVES 1) Identify differences in COVID-19 coping styles and COVID-19 preventive behaviors among cancer survivors in active treatment, survivors not in treatment, and a comparison group without a cancer history. 2) Exploring variables that may predict adherence to COVID-19 preventative behaviors. PATIENT INVOLVEMENT & METHODS This study used an online survey among two categories of cancer survivors - one group in active treatment and one group no longer in treatment - and one group without a cancer history (N = 897 total). RESULTS AND DISCUSSION Cancer survivors in treatment were more likely to utilize both active and disengaged coping (p < .001). This could indicate that the additional COVID-19 strain is making survivors more likely to engage in coping in any way possible. Cancer survivors not in treatment were less likely to report intent to carry out COVID- 19 preventative behaviors compared to the comparison group (p = .009). Providers should understand how survivors may use both coping mechanism types because these coping strategies predict both depression and adherence to COVID-19 preventive behaviors.
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Affiliation(s)
- Jeanine P D Guidry
- Virginia Commonwealth University, Robertson School of Media and Culture, 901 W. Main Street, Suite 2216, Richmond, VA 23284, USA.
| | - Carrie A Miller
- University of Florida, STEM Translational Communication Center, Gainesville, FL, USA
| | - Paul B Perrin
- University of Virginia, Department of Psychology, Charlottesville, VA, USA
| | - Kellie E Carlyle
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA, USA
| | - Matthew W Savage
- San Diego State University, School of Communication, San Diego, CA, USA
| | - Vanessa B Sheppard
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA, USA
| | - Bernard F Fuemmeler
- Virginia Commonwealth University, Department of Family Medicine and Epidemiology, Richmond, VA, USA
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Gómez-Trillos S, Graves KD, Fiallos K, Schwartz MD, Peshkin BN, Hamilton H, Sheppard VB, Vadaparampil ST, Campos C, Cupertino AP, Alzamora MC, Lynce F, Hurtado-de-Mendoza A. Cultural adaptations to a telephone genetic counseling protocol and booklet for Latina breast cancer survivors at risk for hereditary breast and ovarian cancer. Transl Behav Med 2023; 13:297-308. [PMID: 36694918 PMCID: PMC10182423 DOI: 10.1093/tbm/ibac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Telephone genetic counseling (TGC) is accepted as standard clinical care for people seeking hereditary cancer risk assessment. TGC has been shown to be non-inferior to in-person genetic counseling, but trials have been conducted with a predominantly highly educated, non-Hispanic White population. This article describes the process of culturally adapting a TGC protocol and visual aid booklet for Spanish-preferring Latina breast cancer survivors at risk for hereditary breast and ovarian cancers. The adaptation process included two phases. Phase 1 involved a review of the literature and recommendations from an expert team including community partners. Phase 2 included interviews and a pilot with the target population (n = 14) to collect feedback about the adapted protocol and booklet following steps from the Learner Verification and Revision Framework. We describe the adaptation process and report the main adaptations following the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME). Adaptations in Phase 1 were responsive to the target population needs and characteristics (e.g., delivered in Spanish at an appropriate health literacy level, addressing knowledge gaps, targeting cultural values). Phase 2 interviews were crucial to refine details (e.g., selecting words) and to add components to address GCT barriers (e.g., saliva sample video). Cultural adaptations to evidence-based TGC protocols can increase the fit and quality of care for historically underserved populations. As TGC visits become routine in clinical care, it is crucial to consider the needs of diverse communities to adequately promote equity and justice in cancer care.
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Affiliation(s)
- Sara Gómez-Trillos
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Katie Fiallos
- Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Beth N Peshkin
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Heidi Hamilton
- Department of Linguistics, Georgetown University, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University, VA, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Ana Paula Cupertino
- School of Medicine and Dentistry, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Maria C Alzamora
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, DC, USA
| | | | - Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
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10
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Sheppard VB, Sutton AL, Hurtado-De-Mendoza A, Tariq F, Perera RA, Quillin J, Jeudy M, Gomez-Trillos S, Schwartz MD. Addressing disparities in the uptake of genetic counseling and testing in African American women; rationale, design and methods. Contemp Clin Trials 2023:107210. [PMID: 37142159 DOI: 10.1016/j.cct.2023.107210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Genetic counseling and testing (GCT) informs risk reduction and management strategies in women at risk for carrying a pathogenic variation in the BRCA1 or BRCA2 (BRCA1/2) genes. African American (hereinafter referred to as Black) women are less likely to receive GCT services for hereditary breast and ovarian cancer (HBOC). The objective of this work was to examine existing literature regarding successful culturally tailored GCT interventions for Black women and to describe the rationale and protocol for a randomized feasibility trial to test the efficacy of a culturally tailored GCT intervention. METHODS/DESIGN The For Our Health (FOH) study is a two-arm randomized control trial designed to test the efficacy of a video intervention to promote the uptake of GCT among Black women with a high risk of HBOC. The culturally tailored video intervention targets key beliefs, knowledge gaps, misconceptions, and key anticipated emotions relevant for GCT. After completing the baseline survey, 50 women at risk of HBOC will be randomized (1:1) to one of two trial arms: a YouTube video intervention or a publicly available fact sheet. Final assessments will immediately follow receipt of either video or fact sheet. CONCLUSION Few studies have tested interventions to improve GCT uptake among Black women. The FOH trial will fill an important scientific gap in knowledge regarding strategies to reduce disparities in GCT among Black women at risk of HBOC.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America.
| | - Arnethea L Sutton
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, United States of America
| | | | - Fariha Tariq
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Robert A Perera
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
| | - John Quillin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Myrlene Jeudy
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Sara Gomez-Trillos
- Cancer Prevention and Control Program, Georgetown University, Washington DC, USA
| | - Marc D Schwartz
- Cancer Prevention and Control Program, Georgetown University, Washington DC, USA
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11
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Kim SJ, Retnam RP, Sutton AL, Edmonds MC, Bandyopadhyay D, Sheppard VB. Racial disparities in opioid prescription and pain management among breast cancer survivors. Cancer Med 2023; 12:10851-10864. [PMID: 36916310 PMCID: PMC10225217 DOI: 10.1002/cam4.5755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND We examined whether there are racial disparities in pain management, opioid medicine prescriptions, symptom severity, and quality of life constructs in breast cancer survivors. METHODS We conducted a secondary analysis of longitudinal data from the Women's Hormonal Therapy Initiation and Persistence (WHIP) study (n = 595), a longitudinal study of hormonal receptor-positive breast cancer survivors. Upon study enrollment, patients completed a survey assessing an array of psychological, behavioral, and treatment outcomes, including adjuvant endocrine therapy (AET)-induced symptoms, and provided a saliva biospecimen. Opioid prescription records were extracted from the health maintenance organizations (HMOs) pharmacy database. The final analytic sample included women with complete HMO pharmacy records for 1 year. RESULTS There were 251 eligible patients, of which 169 (67.3%) were White. The average age was 61.09 years old (SD = 11.07). One hundred seventy-two patients (68.5%) had received at least one opioid medication and 37.1% were prescribed opioids longer than 90 days (n = 93). Sixty-four Black patients (78%) had a record of being prescribed with opioids compared to 64% of White patients (n = 108, p = 0.03). Black patients reported worse vasomotor, neuropsychological, and gastrointestinal symptoms, as well as lower quality of life and greater healthcare discrimination than White patients (p's < 0.05). Black patients were more likely to be prescribed opioids for 90 days or longer compared to White patients, when controlling for age, marital status, income, body mass index (BMI), cancer stage, and chemotherapy status (adjusted Odds Ratio = 2.72, p = 0.014). CONCLUSION Findings indicate that there are racial differences in opioid prescriptions supplied for pain management and symptomatic outcomes. Future research is needed to understand the causes of disparities in cancer pain management and symptomatic outcomes.
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Affiliation(s)
- Sunny Jung Kim
- Department of Health Behavior and Policy, School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | | | - Arnethea L. Sutton
- Department of Health Behavior and Policy, School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Megan C. Edmonds
- Division of General Internal MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Dipankar Bandyopadhyay
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
- Department of Biostatistics, School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Vanessa B. Sheppard
- Department of Health Behavior and Policy, School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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12
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Edmonds MC, Dahman B, Kim SJ, McGuire KP, Sheppard VB. Surveillance Mammography Behaviors in Black and White Breast Cancer Survivors: Behavioral Risk Factors and Surveillance System, 2016. BMC Womens Health 2023; 23:148. [PMID: 36997881 PMCID: PMC10061852 DOI: 10.1186/s12905-023-02246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 02/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Surveillance mammography is recommended annually for early detection of disease relapse among breast cancer survivors; yet Black women have poorer national rates of surveillance mammography compared to White women. Factors that influence racial disparities in surveillance mammography rates are poorly understood. The purpose of this study is to evaluate the contribution of health care access, socioeconomic status, and perceived health status on adherence to surveillance mammography among breast cancer survivors. METHODS This is a secondary analysis of a cross-sectional survey among Black and White women ≥ 18 years, who reported a breast cancer diagnosis and completed breast surgery and adjuvant treatment from the 2016 Behavioral Risk Factor Surveillance System National Survey (BRFSS). Bivariate associations (chi-squared, t-test) for independent variables (e.g., health insurance, marital status) were analyzed with adherence to nationally recommended surveillance guidelines defined as two levels: adherent (received a mammogram in the last 12 months), vs. non- adherent ("received a mammogram in the last 2-5 years, 5 or more years or unsure). Multivariable logistic regression models were used to evaluate the relationship between study variables with adherence, while adjusting for potential confounders. RESULTS Of 963 breast cancer survivors, 91.7% were White women with an average age of 65. 71.7% reported a surveillance mammogram in the last 12 months, while 28.2% did not. Diagnosed > 5 years (p < 0.001); not having a routine checkup visit within 12 months (p = 0.045); and not seeing a doctor when needed due to cost (p = 0.026), were significantly related to survivor's non-adherence to surveillance mammography guidelines. A significant interaction was found between race and residential area (p < 0.001). Compared to White women, Black women living in metropolitan/suburban residential areas were more likely to receive surveillance guidelines (OR:3.77;95% CI: 1.32-10.81); however Black women living in non-metropolitan areas were less likely to receive a surveillance mammogram compared to White women living in non-metropolitan areas (OR: 0.04; 95% CI: 0.00-0.50). CONCLUSION Findings from our study further explain the impact of socioeconomic disparities on racial differences in the use of surveillance mammography among breast cancer survivors. Black women living in non-metropolitan counties are an important subgroup for future research and screening and navigation interventions.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, 17 E. 102 St, New York, NY, USA.
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- VCU Massey Cancer Center, Richmond, VA, USA
| | - Kandace P McGuire
- VCU Massey Cancer Center, Richmond, VA, USA
- Department of Surgery, VCU Massey Cancer Center, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- VCU Massey Cancer Center, Richmond, VA, USA
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13
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Kim Y, Lee Franco R, Lucas AR, Sutton AL, LaRose JG, Kenyon J, Via J, Cheng RK, D’Agostino RB, Sheppard VB, Hundley WG. Prevalence of Cardiovascular Diseases Among Breast Cancer Survivors: Findings From the NHANES 2003-2018. Am J Health Promot 2023; 37:233-238. [PMID: 35975972 PMCID: PMC10981503 DOI: 10.1177/08901171221120910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To examine the prevalence of cardiovascular diseases (CVD) among breast cancer (BC) survivors. DESIGN Cross-sectional observational study using the data from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. SETTING United States (US). SUBJECTS A nationally representative sample of US women with a history of BC. MEASURES Self-reported CVD status (i.e., coronary artery disease (CAD), heart failure, and stroke) and time of the CVD diagnosis were used to categorize BC survivors into three groups: No CVD, preexisting CVD, and post-acquired CVD after BC diagnosis. ANALYSIS The prevalence of CVD among BC survivors were estimated by demographic characteristics. Complex sampling design of the NHANES was accounted to estimate the population-level prevalence. RESULTS A total of 658 BC survivors were identified, representing 3.01% (≈3.4 million) of the US women aged ≥18 years old. Of those, ≈6% (≈.2 million) had preexisting CVD and ≈11% (≈.4 million) had at least one CVD diagnosed after BC diagnosis, with an average time elapsed ranging from ≈5 years for heart failure to ≈9 years for CAD and stroke. The prevalence of CVD among BC survivors differed by demographic characteristics including age, education, marital status, menopausal, and physical activity levels. CONCLUSION Our findings suggest that BC survivors are at risk of suffering from CVD and public health strategies for the long-term management of CVD risk factors in this vulnerable population group is recommended.
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Affiliation(s)
- Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - R. Lee Franco
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Alexander R. Lucas
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Arnethea L. Sutton
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica G. LaRose
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Jonathan Kenyon
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeremy Via
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard K. Cheng
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Ralph B. D’Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Vanessa B. Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - W. Gregory Hundley
- Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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14
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Preston MA, Cadet D, Hunley R, Retnam R, Arezo S, Sheppard VB. Health Equity and Colorectal Cancer Awareness: a Community Health Educator Initiative. J Cancer Educ 2023; 38:225-230. [PMID: 34677801 PMCID: PMC8532449 DOI: 10.1007/s13187-021-02102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 06/13/2023]
Abstract
Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. Our Community Outreach and Engagement (COE) activities are grounded in a bi-directional Community-to-Bench model in which the National Outreach Network Community Health Educator (NON CHE) Screen to Save (S2S) initiative was implemented. In this study, we assessed the impact of the NON CHE S2S in rural and underserved communities. Descriptive and comparative analyses were used to examine the role of the NON CHE S2S on CRC knowledge and CRC screening intent. Data included demographics, current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to survey scores for CRC knowledge. The NON CHE S2S engaged 441 participants with 170 surveys completed. The difference in participants' CRC knowledge before and after the NON CHE S2S intervention had an overall mean of 0.92 with a standard deviation of 2.56. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p = 0.007) more questions on average than Black participants. After the NON CHE S2S intervention, this difference was not statistically significant. Greater than 95% of participants agreed that the NON CHE S2S sessions impacted their intent to get screened for CRC. Equity of access to health information and the health care system can be achieved with precision public health strategies. The COE bi-directional Community-to-Bench model facilitated community connections through the NON CHE and increased awareness of CRC risk reduction, screening, treatment, and research. The NON CHE combined with S2S is a powerful tool to engage communities with the greatest health care needs and positively impact an individual's intent to "get screened" for CRC.
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Affiliation(s)
- Michael A Preston
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA.
| | - Debbie Cadet
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Rachel Hunley
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Reuben Retnam
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Sarah Arezo
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research-Community Outreach & Engagement, Virginia Commonwealth University, PO Box 980149, 830 East Main Street, Richmond, VA, 23298-0149, USA
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15
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Huang ER, Longcoy J, Shen J, Hsiao SC, Hsiao HY, Isaacs C, Sheppard VB, Wang JHY. Exploring Racial Differences in Treatment Decision-making in Chinese Immigrant and White American Breast Cancer Patients: the Role of Patient-Provider Communication. J Cancer Educ 2023; 38:66-73. [PMID: 34392497 PMCID: PMC9165569 DOI: 10.1007/s13187-021-02079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
Chinese immigrant cancer patients report suboptimal patient-provider communication, which increases the likelihood of decisional conflict and unsatisfactory treatment decision-making (TDM) outcomes (e.g., low satisfaction and perceived control over cancer care). This cross-sectional study explored whether (1) communication and decisional conflict factors associated with TDM outcomes differed between Chinese immigrant and non-Hispanic White breast cancer patients, and (2) the association between patient-provider communication and the outcomes were mediated by TDM factors, regardless of race. Ninety-eight breast cancer patients, diagnosed at stage I-III participated in cross-sectional survey interviews. TDM outcomes and possible predictors of the outcomes (e.g., patient-provider communication, decisional conflict, preference for who makes the treatment decision) were assessed. Linear regression and mediational testing were performed to examine associations among variables of interest. Of the 98, 85 were included for analysis. Chinese patients with limited English proficiency (n = 37) had poorer patient-provider communication, higher decisional conflict, and preferred providers to make decisions than non-Hispanic White patients (n = 48; all p < .05). They also had lower satisfaction with their TDM process after controlling for predictors (e.g., patient-provider communication) (p < .001). There were no significant racial differences in perceived control, controlling for covariates. Regardless of race, patients who reported quality patient-provider communication reported less decisional conflict. These patients also reported increased satisfaction and perceived control. The disparities Chinese immigrant cancer patients experienced in the TDM process may be related to their cultural communication style with providers. Facilitating Chinese patients' communication and partnership with providers may reduce decisional conflicts and increase their TDM outcomes.
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Affiliation(s)
- Ellen R Huang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Joshua Longcoy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
- Department of Biostatistics, Epidemiology, and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | | | - Suh-Chen Hsiao
- University of Southern California Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Hsin-Yi Hsiao
- Department of Social Work, Tzu Chi University, Hualien, Taiwan
| | - Claudine Isaacs
- Department of Oncology, Fisher Center for Hereditary Cancer and Clinical Genomics Research, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Massey Cancer Center Office of Health Equity Disparities Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Judy Huei-Yu Wang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA.
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16
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Edmonds MC, Kim SJ, Wells M, Dahman B, Sheppard VB. A Mixed Method Approach to Examine Surveillance Mammography Experiences in Black and White Breast Cancer Survivors. Clin Breast Cancer 2022; 22:801-811. [PMID: 36137937 DOI: 10.1016/j.clbc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The use of surveillance mammography following a breast cancer (BC) diagnosis is associated with early detection of disease relapse and increased overall survival; yet Black women compared to White women have the lowest surveillance mammography rates, with limited explanation. To further understand this racial disparity the present study examines the association of mammography beliefs, knowledge, and healthcare delivery factors on receipt of surveillance mammography among Black and White breast cancer survivors. METHODS This is a convergent parallel mixed method study design of an online survey and online focus groups among Black and White BC survivors (N = 266) recruited from community engagement. The online focus groups consisted of a series of theory-informed questions via social media platforms (eg Breastcancer.org, Quora, Reddit). An in-depth thematic analysis approach was used to extract themes from online focus group data. Bivariate (χ2) and multivariable logistic regression analyses were conducted using the survey data to examine associated factors with receipt of a surveillance mammography within 12 months (yes vs. no). RESULTS 76% (n = 177) of women were Black, 62% were <5 years since diagnosis, 98% had health insurance, with an age range from 23 to 79 (mean = 55) years. 72% of the sample received a surveillance mammogram relative to 27%. Women more frequently received a surveillance mammogram if they reported perceived mammography benefits (<.001), underwent lumpectomy (P< .001) and had health insurance (P = .04). Black women without communication about surveillance care with providers had a lower likelihood of receiving a surveillance mammogram (OR:0.09,95% CI: 0.01-0.45, P = .003). Thematic findings from online focus groups included motivators for receipt of surveillance mammograms: physician recommendation, regular physical exams, and knowledge of recommended guidelines. Barriers of non-receipt of surveillance mammograms included: transportation, medical cost/financial barriers, feeling ignored from providers, and medical mistrust. CONCLUSION Women may require more individualized information regarding their surveillance care to support routine guideline concordant follow-up. Patient-provider-communication is an integral part of Black survivors' surveillance care needs. Improving patient-provider communication for Black women's is necessary to address this group cancer care needs.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Matthew Wells
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA; VCU Massey Cancer Center, Richmond, VA
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA; VCU Massey Cancer Center, Richmond, VA
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17
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Cabling ML, Drago F, Turner J, Hurtado-de-Mendoza A, Sheppard VB. Revisiting agency and medical health technology: actor network theory and breast cancer survivors’ perspectives on an adherence tool. Health Technol 2022; 12:1071-1084. [PMID: 36406185 PMCID: PMC9660207 DOI: 10.1007/s12553-022-00707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
Purpose Optimal treatment adherence is critical in the management of breast cancer patients/survivors taking hormonal therapy. However, lack of adherence is common. Many technologies have been developed to encourage medication intake, such as reminders on phones or digital pills, with varying degrees of success. Methods To explore the role of technology in medical adherence requires a framework that considers all complexities of technology, from software to the end user’s beliefs. Actor Network Theory (ANT) defines technology based on its technical, social, and abstract components. We conducted three focus groups, which we analyzed using a thematic analysis to determine topics in breast cancer survivors’ discussions of these technologies. We also conducted a deductive content analysis using ANT concepts as codes. Results In discussing the use of technology to improve medical adherence, participants had an empowering view of technology (48.8%) a neutral one (41.5%) or a disempowering view (9.8%). When it comes to their medication adherence, breast cancer survivors taking hormonal therapy perceived technology as something on which they could assert agency while their own agency dictated their adherence behaviors. Conclusions In line with a non-technologically deterministic view of medical technologies, this finding shows that technology can be both constraining and enabling, depending on the specific context of human use. This networked understanding of technology in terms of social dynamics has relevant implications in designing interventions that use technology to improve adherence.
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Affiliation(s)
- Mark L. Cabling
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Ste. 4100, 20007 Washington DC, USA
| | - Fabrizio Drago
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854 USA
| | - Jeanine Turner
- Communication, Culture & Technology Program, Graduate School of Arts and Sciences, Georgetown University Car Barn, Suite 311, 3520 Prospect Street, Washington DC , N.W. 20057 USA
| | - Alejandra Hurtado-de-Mendoza
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Ste. 4100, 20007 Washington DC, USA
| | - Vanessa B. Sheppard
- Massey Cancer Center, School of Medicine, Virginia Commonwealth University, 401 College Street, Box 980037, Richmond, VA 23298-0037 USA
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Kim Y, Franco RL, Lucas AR, Sutton AL, LaRose JG, Kenyon J, Via J, Sheppard VB, Hundley GW. Prevalence Of Cardiovascular Diseases And Risk Factors Among Breast Cancer Survivors: Findings From Nhanes. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000875084.58056.6d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Beisel C, Poretta T, Sheppard VB, Hurtado-de Mendoza A, Sipsma H, Fuqua E, Stwalley B, Salvatore A, Yang M. Adherence to Adjuvant Therapy in Patients with Resected Melanoma: An Application of the Theory of Planned Behavior. Adv Ther 2022; 39:4061-4075. [PMID: 35776398 PMCID: PMC9402483 DOI: 10.1007/s12325-022-02221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Adherence to adjuvant therapy is crucial for effective disease management in patients with resected melanoma. This study assessed patient-reported adherence to adjuvant therapy and identified behavioral/belief constructs associated with adherence in patients with resected melanoma. METHODS Patients with resected stage III/IV melanoma were recruited through the Melanoma Research Foundation and a patient panel to complete an online survey. Patient characteristics, medical history, and adherence to therapy were captured. In accordance with the theory of planned behavior (TPB), the survey measured behavioral, normative, and control beliefs, and intention to adhere to therapy. Structural equation modeling (SEM) examined their relationships with adherence. RESULTS Among all patients who received adjuvant therapy and completed the survey (n = 184), 69% received intravenous and 31% received oral therapy; the majority (85.3%) were somewhat involved in deciding to start therapy. Mean age was 45 years, 44% of patients were female, and 83% had stage III/IV disease at diagnosis. Patients had a mean disease duration of 1.5 years, a time since complete resection of 10 months, and an adjuvant therapy duration of 8 months. Adherence to adjuvant therapy was high overall and higher with intravenous than with oral therapy (98.4% versus 91.2%, P = 0.002). All underlying TPB constructs were significant in the SEM model, which explained 60.3% of the variance in intention to adhere. Control beliefs had the strongest association with intention to adhere (standardized estimate = 0.47, P < 0.001) and intravenous therapy was associated with greater adherence than oral therapy (standardized estimate = 0.26, P < 0.001). CONCLUSIONS This study found that patients with resected melanoma are highly engaged in the decision to initiate systemic adjuvant therapy, with an overall high adherence rate to prescribed adjuvant treatment. Enhancing patients' view of their capability to adhere to treatments may further improve the adherence rate to melanoma adjuvant therapy.
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Affiliation(s)
| | - Tayla Poretta
- Bristol Myers Squibb, Princeton, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA.
| | - Vanessa B Sheppard
- Virginia Commonwealth University School of Medicine, Richmond and Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | | | | | | | - Brian Stwalley
- Bristol Myers Squibb, Princeton, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA
| | - Anthony Salvatore
- Bristol Myers Squibb, Princeton, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA
| | - Min Yang
- Analysis Group, Inc., Boston, MA, USA
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20
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Hurtado-de-Mendoza A, Reyna VF, Wolfe CR, Gómez-Trillos S, Sutton AL, Brennan A, Sheppard VB. Adapting a Theoretically-Based intervention for underserved clinical populations at increased risk for hereditary Cancer: Lessons learned from the BRCA-Gist experience. Prev Med Rep 2022; 28:101887. [PMID: 35855922 PMCID: PMC9287635 DOI: 10.1016/j.pmedr.2022.101887] [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: 12/22/2021] [Revised: 06/04/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
The use of GCT in underserved diverse populations is suboptimal. Translational genomics research has been conducted with mostly NHW. Adapting EBIs can enhance the reach of EBI to underserved diverse populations. This paper describes the adaptation BRCA Gist, for at-risk Blacks and Latinas. Findings illustrate the need to integrate fidelity and adaptation considerations.
Background Minorities at increased risk for Hereditary Breast and Ovarian Cancer (HBOC) frequently have low awareness and use of genetic counseling and testing (GCT). Making sure that evidence-based interventions (EBIs) reach minorities is key to reduce disparities. BRCA-Gist is a theory-informed EBI that has been proven to be efficacious in mostly non-Hispanic White non-clinical populations. We conducted formative work to inform adaptations of BRCA-Gist for use in clinical settings with at-risk diverse women. Methods Genetic counselors (n = 20) were recruited nationally; at-risk Latinas and Blacks (n = 21) were recruited in Washington DC and Virginia. They completed the BRCA-Gist EBI between April 2018 – September 2019. Participants completed an acceptability scale and an interview to provide suggestions about implementation adaptations. T-tests for independent samples compared acceptability between at-risk women and genetic counselors. The Consensual Qualitative Research Framework was used to code adaptation suggestions. Suggested adaptations were discussed by a multidisciplinary team to integrate fidelity and adaptation considerations. Results At-risk women had a significantly higher acceptability (M = 4.17, SD = 0.47 vs. M = 3.24, SD = 0.64; p = 0.000; scale 1–5) and satisfaction scores (M = 8.3, SD = 1.3 vs. M = 4.2, SD = 2.0; p = 0.000; scale 1–10) than genetic counselors. Genetic counselors and at-risk women suggested contextual (e.g. format) and content (e.g. shortening) adaptations to enhance the fit of BRCA-Gist for diverse clinical populations. Conclusions Findings illustrate the process of integrating fidelity and adaptation considerations to ensure that EBIs retain their core components while enhancing the fit to minoritized clinical populations. Future studies will test the efficacy of the adapted BRCA-Gist in a Randomized Controlled Trial.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Valerie F Reyna
- Human Neuroscience Institute, Cornell University, Ithaca, NY, USA
| | | | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Arnethea L Sutton
- Department of Health Behavior Policy, Virginia Commonwealth University, VA, USA
| | - Ashleigh Brennan
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, VA, USA
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21
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Chukmaitov A, Dahman B, Garland SL, Dow A, Parsons PL, Harris KA, Sheppard VB. Addressing Social Risk Factors in the Inpatient Setting: Initial Findings from a Screening and Referral Pilot at an Urban Safety-Net Academic Medical Center in Virginia, USA. Prev Med Rep 2022; 29:101935. [PMID: 36161115 PMCID: PMC9501992 DOI: 10.1016/j.pmedr.2022.101935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Social Determinants of Health (SDOH) impact health outcomes; thus, a pilot to screen for important SDOH domains (food, housing, and transportation) and address social needs in hospitalized patients was implemented in an urban safety-net academic medical center. This study describes the pilot implementation and examines patient characteristics associated with SDOH-related needs. An internal medicine unit was designated as a pilot site. Outreach workers approached eligible patients (n = 1,135) to complete the SDOH screening survey at time of admission with 54% (n = 615) completing the survey between May 2019 and July 2020. Data from patient screening survey and electronic health records were linked to allow for examination of associations between SDOH needs for food, housing, and transportation and various demographic and clinical characteristics of patients in multivariate logistic regression models. Of 615 screened patients, 45% screened positive for any need. Of 275 patients with needs, 33% reported needs in 2, and 34% – in 3 domains. Medicaid beneficiaries were more likely than patients with private health insurance to screen positive for 2 and 3 needs; Black patients were more likely than White patients to screen positive for 1 and 3 needs; Patients with no designated primary care physician status screened positive for 1 need; Patients with a history of substance use disorder screened positive for all 3 needs. SDOH screening assisted in addressing social risk factors of inpatients, informed their discharge plans and linkage to community resources. SDOH screening demonstrated significant correlations of positive screens with race/ethnicity, insurance type, and certain clinical characteristics.
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Affiliation(s)
- Askar Chukmaitov
- Virginia Commonwealth University (VCU) School of Medicine, Department of Health Behavior and Policy, 830 E. Main Str, Richmond, VA 23219, USA
- Corresponding author.
| | - Bassam Dahman
- Virginia Commonwealth University (VCU) School of Medicine, Department of Health Behavior and Policy, 830 E. Main Str, Richmond, VA 23219, USA
| | | | - Alan Dow
- VCU School of Medicine, Division of Hospital Medicine; VCU Health Sciences for Interprofessional Education & Collaborative Care; VCU Health Continuing Education; VCU Department of Health Administration, Richmond, USA
| | - Pamela L. Parsons
- VCU School of Nursing, Department of Family and Community Health Nursing; Richmond Memorial Health Foundation, Richmond, USA
| | - Kevin A. Harris
- VCU School of Medicine Dean's Office for Diversity, Equity and Inclusion, Richmond, USA
| | - Vanessa B. Sheppard
- Virginia Commonwealth University (VCU) School of Medicine, Department of Health Behavior and Policy, 830 E. Main Str, Richmond, VA 23219, USA
- VCU Massey Cancer Center, Richmond, USA
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22
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Shen J, Fuemmeler BF, Sheppard VB, Bear HD, Song R, Chow WH, Zhao H. Neighborhood disadvantage and biological aging biomarkers among breast cancer patients. Sci Rep 2022; 12:11006. [PMID: 35773311 PMCID: PMC9246873 DOI: 10.1038/s41598-022-15260-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/21/2022] [Indexed: 11/09/2022] Open
Abstract
Living in a disadvantaged neighborhood is associated with adverse clinical outcomes among breast cancer patients, but the underlying pathway is still unclear. Limited evidence has suggested that accelerated biological aging may play an important role. In this study, using a sub-sample of 906 women with newly diagnosed breast cancer at M.D. Anderson, we examined whether levels of selected markers of biological aging (e.g., allostatic load, telomere length, and global DNA methylation) were affected by neighborhood disadvantage. The Area Deprivation Index was used to determine the neighborhood disadvantage. Based on the median ADI at the national level, the study population was divided into low and high ADI groups. Overall, breast cancer patients from the high ADI group were more likely to be younger and non-Hispanic Black than those from the low ADI group (P < 0.001, respectively). They were also more likely to have higher grade and poorly differentiated breast tumors (P = 0.029 and 0.019, respectively). For the relationship with markers, compared to the low ADI group, high ADI group had higher median levels of allostatic load (P = 0.046) and lower median levels of global DNA methylation (P < 0.001). Compared to their counterparts, those from the high ADI group were 20% more likely to have increased allostatic load and 51% less likely to have increased levels of global DNA methylation. In summary, we observed that levels of allostatic load and global DNA methylation are influenced by neighborhood disadvantage among breast cancer patients.
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Affiliation(s)
- Jie Shen
- Departments of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Bernard F Fuemmeler
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Vanessa B Sheppard
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Harry D Bear
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Renduo Song
- Departments of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Wong-Ho Chow
- Departments of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Hua Zhao
- Departments of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA.
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23
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Carrera P, Sheppard VB, Caballero A, Gómez-Trillos S, Hurtado-de-Mendoza A. A culturally targeted video to promote genetic counseling in a community sample of at-risk US Latina women: The role of the concrete mindset. J Community Psychol 2022; 50:1331-1342. [PMID: 34606624 DOI: 10.1002/jcop.22718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/24/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Latina women, who are at increased risk of hereditary breast and ovarian cancer (HBOC), have lower use of genetic counseling and testing (GCT) than non-Hispanic White women. In a recent study, culturally targeted video improved psychosocial outcomes related to GCT. Additional analyses examine whether the culturally targeted video improved positive reactions in women who focus on difficulties (concrete mindset) versus women who focus on the final goals (abstract mindset). Participants (N = 32) completed surveys before and immediately after watching the video. The surveys measured attitudes, emotions, and women's mindset. Before watching the video, women with a concrete mindset reported more negative attitudes and negative emotions about GCT than women with an abstract mindset. After watching the video, women with a concrete mindset reported negative attitudes and feelings at levels comparable to those of women with an abstract mindset, reflecting a reduction in their negative attitudes and emotions. The sample size limits the power to find statistically significant differences. Results support the relevance of considering the audience's mindset in the development and testing of public health messages to promote the use of GCT.
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Affiliation(s)
- Pilar Carrera
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Amparo Caballero
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
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24
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Oppong BA, Bhattacharyya O, Li Y, Obeng-Gyasi S, Sheppard VB. Receipt of breast conservation over mastectomy in Black women- does breast cancer subtype matter? J Natl Med Assoc 2022; 114:298-307. [PMID: 35272849 DOI: 10.1016/j.jnma.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breast conservation surgery (BCS) and mastectomy have equivalent survivability. However, perception of surgical benefit may be affected by breast cancer subtypes, impacting procedure choice. We evaluate surgical management among non-Hispanic Black (NHB) and White (NHW) breast cancer patients based on subtypes. METHODS Queried the National Cancer Database (NCDB) including BCS eligible women with T1 (<2cm) breast cancer between 2011 and 2016. We selected NHB and NHW women and evaluated differences in sociodemographic variables and treatment including surgery. To determine factors associated with receipt of BCS, a multivariable logistic regression analysis was performed adjusting for age, race, surgery type and breast cancer subtypes. RESULTS Analyzed 390,278 women with 89.7% NHW and 10.3% NHB, of mean age 63 years. 55.4% vs. 53.5% of NHW compared to NHB women had BCS (p<.001) as initial cancer therapy. Statistically significant differences between NHB and NHW in surgery were found on univariate analysis in all breast cancer subtypes except Luminal B. NHB women with TNBC and Luminal A subtypes were more likely to undergo BCS on multivariate analysis. CONCLUSIONS Significant differences are found in the surgical management of breast cancer with Black women more likely to receive BCS, less likely to undergo mastectomy compared to White counterparts even with TNBC or her-2+ subtypes. Understanding surgical decision making and how knowledge of subtype is applied deserves further study in women of diverse racial and ethnic groups.
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Affiliation(s)
- Bridget A Oppong
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA.
| | - Oindrila Bhattacharyya
- Indiana University Purdue University Indianapolis, Department of Economics, Indianapolis, IN, USA; Regenstrief Institute Inc., The William Tierney Center for Health Services Research, Indianapolis, IN, USA
| | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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25
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Guidry JPD, Carlyle KE, Miller CA, Ksinan AJ, Winn R, Sheppard VB, Fuemmeler BF. Endorsement of COVID-19 related misinformation among cancer survivors. Patient Educ Couns 2022; 105:265-268. [PMID: 34030928 PMCID: PMC8139169 DOI: 10.1016/j.pec.2021.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To determine whether cancer survivors currently in treatment are more or less likely to endorse COVID-19 related misinformation compared to their counterparts no longer in treatment and those without a cancer history. METHODS We conducted a Qualtrics survey among 897 adults to determine differences in endorsement of COVID-19 misinformation among cancer survivors in active treatment, cancer survivors no longer in treatment, and a control group with no cancer history. RESULTS Cancer survivors currently undergoing treatment were more likely to believe misinformation related to COVID-19 than those without a cancer history. Least likely to endorse COVID-19 misinformation were cancer survivor no longer in treatment. CONCLUSION These results alert healthcare professionals to overall high levels of endorsement of COVID-19 misinformation among cancer survivors on active treatment. Oncologists and other providers working with patients undergoing treatment for cancer should be particularly mindful of the potential elevated beliefs in misinformation among this group. PRACTICAL IMPLICATIONS Since patients undergoing cancer treatment seem to be particularly vulnerable to COVID-19 misinformation, oncologists and other healthcare providers working with this patient population should help address patients' concerns about the pandemic and how it relates to their course of treatment.
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Affiliation(s)
- Jeanine P D Guidry
- Robertson School of Media and Culture, Virginia Commonwealth University, Richmond, VA, USA.
| | - Kellie E Carlyle
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Carrie A Miller
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Robert Winn
- Massey Cancer Center and Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, and Massey Cancer Center, Richmond, VA, USA
| | - Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, and Massey Cancer Center, Richmond, VA, USA
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26
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Edmonds MC, Dahman B, McGuire K, Sheppard VB. Influential factors in Black and White breast cancer survivors' beliefs about breast cancer. Psychooncology 2022; 31:271-281. [PMID: 34590395 PMCID: PMC8818015 DOI: 10.1002/pon.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Breast cancer beliefs are widely studied to improve preventative screening behaviors in women without cancer; however, limited research has examined breast cancer beliefs among breast cancer survivors. To fill this gap in research we investigated racial differences and the predicting role of influential factors (e.g., stage) in survivors' beliefs about their breast cancer. METHODS This study is a secondary analysis of data from the Narrowing Gap in Adjuvant Therapy Study (2006-2011), where Black (N = 210) and White women (N = 149) were interviewed within 20 weeks following their breast cancer diagnosis and primary surgery in Washington DC and Detroit, MI. Outcomes of this analysis were perceived susceptibility to a breast cancer recurrence and perceived severity of breast cancer. Bivariate analyses were conducted to assess racial differences in sample characteristics, and on the study outcomes. Adjusted multiple regression models examined correlates between independent variables (e.g., sociodemographic/clinical) and women's breast cancer beliefs about susceptibility of a recurrence and disease severity. RESULTS Most of the sample were Black women (58%), had breast-conserving surgery (64%), and were privately insured (67%). Black women reported higher perceived disease severity beliefs than White women (p = 0.004). Other associated factors with greater perceived severity beliefs included lower education (p = 0.008), public health insurance (p = 0.021) and greater levels of medical mistrust (p = 0.016). In our adjusted multiple regression models' women with lower satisfaction regarding financial aspects of their healthcare were more likely to have higher perceived severity beliefs (p = 0.007); women with stage II cancer compared to stage I had greater susceptibility beliefs to a cancer recurrence (p = 0.001). CONCLUSION We found racial differences in women's perceived severity beliefs, and identified theory-based clinical and psychosocial correlates in survivor's breast cancer beliefs by race. Specifically, women diagnosed at stage (II) compared to stage (I) reported greater perceived susceptibility to a recurrence. Survivors diagnosed at stage (I) and (III) cancers may serve as important target groups to monitor their surveillance and follow-up behaviors. This study contributes salient predictors in survivors' beliefs about their BC and informs navigation strategies to improve cancer survivorship recommendations in the context of psycho-oncology and follow-up cancer care.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kandace McGuire
- Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
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Sutton AL, Thomson MD, Huratdo-de-Mendoza A, Sheppard VB. Abstract PO-109: “At some point or another, it has affected all of my five senses.”: A qualitative assessment of treatment-related side effects in Black and White breast cancer survivors. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-109] [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: Racial disparities in breast cancer outcomes persist and are attributed to multiple factors; however, treatment-related side effects, one of the most frequently implicated reasons for poor quality of life and treatment disruptions have been underexplored as a contributor to the disparity. The purpose of this study was to explore similarities and differences in Black and White women's experiences with breast cancer treatments, with a particular focus on their experiences with side effects. Methods: This was a secondary analysis of qualitative data that were originally collected to understand breast cancer survivor's experiences taking adjuvant endocrine therapy (AET). This analysis focused on discussions about side effects related to multiple treatment modalities, including chemotherapy, radiation, and AET. Women were recruited from healthcare centers and via community organizations in an urban U.S. city. Women were eligible for the study if they identified as Black/African American or White and were taking AET. Participants attended one focus group with women who identified as the same race. Focus groups were conducted between August 2014-August 2015, lasted 90-120 minutes, and were transcribed verbatim. Using an iterative approach, initial open codes were identified by two individuals, compared within and between interviews, and refined to generate themes. Disagreements were resolved via a third reviewer. Results: A total of 21 women attended one of three focus groups (n=16 Black women; n=5 White women). Three overarching themes were identified: Side Effect Recognition, Communication about Side Effects, and Coping with Side Effects. Women's descriptions of their side effects closely mirrored domains of the Functional Assessment of Cancer Therapy Endocrine Therapy scale (e.g., vasomotor symptoms). Black and White women also reported weight changes as a result of adjuvant endocrine therapy (weight gain) and chemotherapy (weight loss). The majority of women in our sample reported at least one side effect; however, reporting ‘no side effects' only occurred among White women. Ratings of provider communication about symptoms were mixed; some women found communication helpful while others reported feeling dismissed. While one woman expressed provider negligence concerning mitigating side effects, another remarked on the accessibility of her provider to answer all her questions. Women discussed various methods to cope with side effects, including exercise and medications to relieve joint and bone pain. Spirituality as a method to cope only emerged in the focus groups with Black women. Conclusion: Black and White women reported relatively similar experiences with treatment-related side effects. Future work is needed to understand why Black women may experience more side effects to treatment. Further, culturally-tailored approaches to address treatment side effects that incorporate spirituality are needed to mitigate side effects, which may ultimately improve treatment adherence, quality of life, and outcomes in Black women.
Citation Format: Arnethea L. Sutton, Maria D. Thomson, Alejandra Huratdo-de-Mendoza, Vanessa B. Sheppard. “At some point or another, it has affected all of my five senses.”: A qualitative assessment of treatment-related side effects in Black and White breast cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-109.
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Affiliation(s)
| | - Maria D. Thomson
- 1Virginia Commonwealth University School of Medicine, Richmond, VA,
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Sheppard VB. Abstract IA-51: If not now, then when? Tackling barriers to clinical trials to ensure inclusion of underrepresented minorities. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-ia-51] [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
The low representation of underrepresented minorities in clinical trials is well known. Unfortunately, there appears to be modest progress in the inclusion of these groups in the nearly 30 years since the NIH Revitalization Act of 1993. Racial and ethnic diversity in clinical trials is imperative for ensuring that novel cancer therapies, behavioral interventions and other types of scientific advances reach and are relevant to all population segments. It will be impossible to eliminate disparities and achieve health equity without diversity and inclusion in clinical research. Many barriers exist to clinical trials and some may be exacerbated among racial/ethnic minorities. This presentation will discuss multilevel barriers to participation in clinical research, share engagement principles related to partnerships with African American/Black and Latino/Latinx populations, and provide lessons learned from institutional and investigator led-initiatives. Data sources include chart reviews, patient interviews and surveys. Selected clinical studies will be discussed along with qualitative and quantitative data. The overall goal is to identify actionable steps towards a collective path of improving minority participation in clinical trials. Strategies that optimize opportunities for system change may have greater impact than strategies that focus solely on patient and/or community attitudes or behaviors. Given the COVID-19 pandemic, public awareness about clinical trials may be at a record high. Thus, community conversations about science and the clarion call for social justice may be the energy needed for cancer scientists to collaborate and change the narrative regarding participation of underrepresented minorities in research.
Citation Format: Vanessa B. Sheppard. If not now, then when? Tackling barriers to clinical trials to ensure inclusion of underrepresented minorities [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-51.
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Affiliation(s)
- Vanessa B. Sheppard
- School of Medicine and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
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Hurtado-de-Mendoza A, Gonzales F, Song M, Holmes EJ, Graves KD, Retnam R, Gómez-Trillos S, Lopez K, Edmonds MC, Sheppard VB. Association between aspects of social support and health-related quality of life domains among African American and White breast cancer survivors. J Cancer Surviv 2021; 16:1379-1389. [PMID: 34655040 PMCID: PMC10166003 DOI: 10.1007/s11764-021-01119-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Social support is associated with breast cancer survivors' health-related quality of life (HRQoL). More nuanced information is needed regarding aspects of social support associated with different HRQoL domains among diverse populations. We assessed the association between emotional/informational and tangible support and five HRQoL domains and evaluated race as an effect modifier. METHODS African American and White women (n = 545) diagnosed with hormone-receptor-positive breast cancer completed a survey that assessed sociodemographic, clinical, and psychosocial factors. We assessed bivariate relationships between emotional/informational and tangible support along with overall HRQoL and each HRQoL domain.We tested interactions between race and emotional/informational and tangible social support using linear regression. RESULTS The sample included African American (29%) and White (71%) breast cancer survivors. Emotional/informational social support had a statistically significant positive association with emotional well-being (β = .08, p = 0.005), social well-being (β = 0.36, p < 0.001), functional well-being (β = .22, p < .001), breast cancer concerns (β = .16, p = 0.002), and overall HRQoL (β = .83, p < .001). Similarly, tangible social support had a statistically significant positive association with emotional well-being (β = .14, p = 0.004), social well-being (β = .51, p < .001), functional well-being (β = .39, p < .001), and overall HRQoL (β = 1.27, p < .001). The interactions between race and social support were not statistically significant (p > 0.05). CONCLUSIONS Results underscore the importance of the different social support types among breast cancer survivors, regardless of survivors' race. IMPLICATIONS FOR CANCER SURVIVORS Population-based interventions can be standardized and disseminated to provide guidance on how to increase emotional/information and tangible support for all breast cancer survivors by caregivers, health providers, and communities.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA. .,Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Felisa Gonzales
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.,The Colorado Trust, Denver, CO, USA
| | - Minna Song
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Esther J Holmes
- Department of Health Behavior and Policy, VCU School of Medicine, Richmond, VA, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Reuben Retnam
- Department of Health Behavior and Policy, VCU School of Medicine, Richmond, VA, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Katherine Lopez
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, VCU School of Medicine, Richmond, VA, USA.,Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
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Thomson MD, Williams AR, Sutton AL, Tossas KY, Garrett C, Sheppard VB. Engaging rural communities in cancer prevention and control research: Development and preliminary insights from a community-based research registry. Cancer Med 2021; 10:7726-7734. [PMID: 34647436 PMCID: PMC8559516 DOI: 10.1002/cam4.4199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/02/2021] [Accepted: 07/30/2021] [Indexed: 01/03/2023] Open
Abstract
Objective To report on the development and preliminary findings of a community‐based cancer registry, including the community‐engaged approach to recruitment, participant profile, and distribution of cancer risk factors by race/ethnicity and geography. Methods Community outreach and engagement best practices were used to recruit a diverse convenience sample of Virginia residents (≥18 years) that oversampled residents living in rural areas, defined as Rural‐Urban Continuum Codes (RUCC) 4–9 and African American (AA)/Black residents. Multiple survey administration methods included electronic (e‐survey) and in‐person survey by community‐based staff. Results At the time of this analysis, 595 participants are enrolled; 73% are rural, 46% are AA/Black. AA/Black participants reported similar education but lower income (p < 0.01) and health literacy (p < 0.01), lower alcohol use (p < 0.001), fewer sedentary behaviors (p = 0.01), but greater BMI (p < 0.05) compared to White participants. Rural residents reported significantly lower household income (p < 0.001) and greater use of Medicaid (p = 0.01) compared to urban participants. Biennial mammography was reported by 82% of women aged 45–74 years old and colonoscopy by 77% of participants ≥50 years old. Tobacco use was reported by 17%; no differences in cancer screening or tobacco use were identified by geography or by race. Conclusion and relevance Community engagement strategies successfully enrolled diverse residents within the cancer service area. AA/Black participants reported fewer cancer risk behaviors, similar educational attainment but lower income and health literacy compared to White respondents. Nuanced examinations of interactions among multilevel factors are needed to understand how individual, community, and institutional factors converge to maintain cancer disparities among AA/Black Virginians. Additional findings indicate a need for tobacco cessation, lung cancer screening, obesity treatment, and prevention initiatives.
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Affiliation(s)
- Maria D Thomson
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia, USA
| | | | | | - Katherine Y Tossas
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia, USA
| | - Charlotte Garrett
- Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia, USA
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Sheppard VB, Sutton A, Holmes E, Edmonds M, Preston MA, Namoos AM, Wells M, Thomson MD. Recruitment of African Americans into Cancer Clinical Research: Strategies and Outcomes. J Urban Health 2021; 98:149-154. [PMID: 34374033 PMCID: PMC8352149 DOI: 10.1007/s11524-021-00565-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
This study utilized data from four cancer-focused research studies that recruited and retained African Americans. Strategies and outcomes across four cancer prevention and control studies were analyzed. Descriptive statistics were used to display participant characteristics. There were 712 African American (Black) participants of which 14.6% were males. Common strategies involved connecting with community stakeholders and identifying study champions. Study recruitment methods might not be generalizable to all populations of African Americans due to geographic locations, study protocols (e.g., risk reduction), target populations (i.e., eligibility criteria), and available resources. Many African Americans have a strong interest in cancer-related research as demonstrated by participation levels. Teams that connect with relevant stakeholders and include diverse teams may be useful to engage larger numbers of minorities in cancer control research to impact morbidity and mortality.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Arnethea Sutton
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Esther Holmes
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Megan Edmonds
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Michael A Preston
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Asmaa M Namoos
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA.
| | - Matthew Wells
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
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Chan RJ, Nekhlyudov L, Duijts SFA, Hudson SV, Jones JM, Keogh J, Love B, Lustberg MB, Mehnert-Theuerkauf A, Nathan P, Ness KK, Sheppard VB, Smith K, Tevaarwerk A, Yu X, Feuerstein M. Future research in cancer survivorship. J Cancer Surviv 2021; 15:659-667. [PMID: 34460055 DOI: 10.1007/s11764-021-01102-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia.
| | | | - Saskia F A Duijts
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | - Brad Love
- Center for Health Communication, University of Texas, Austin, TX, USA
| | | | | | - Paul Nathan
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kirsten K Ness
- FAPTA, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Vanessa B Sheppard
- School of Medicine and the Massey Cancer Center Office of Outreach Engagement and Health Disparities, Virginia Commonwealth University, Richmond, VA, USA
| | - Katherine Smith
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Amye Tevaarwerk
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Xinhua Yu
- University of Memphis School of Public Health, Memphis, TN, USA
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Thomson MD, Mariani AC, Williams AR, Sutton AL, Sheppard VB. Factors Associated With Use of and Satisfaction With Telehealth by Adults in Rural Virginia During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2119530. [PMID: 34351404 PMCID: PMC8343464 DOI: 10.1001/jamanetworkopen.2021.19530] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This survey study examines the use of and satisfaction with telehealth services by adults in rural Virginia during the COVID-19 pandemic.
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Affiliation(s)
- Maria D. Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
- Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia
| | - Abigail C. Mariani
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
| | - April R. Williams
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
| | - Arnethea L. Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
- Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia
| | - Vanessa B. Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
- Office of Community Outreach and Engagement, Massey Cancer Center, Richmond, Virginia
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Sutton AL, Felix AS, Bandyopadhyay D, Retnam R, Hundley WG, Sheppard VB. Cardioprotective medication use in Black and white breast cancer survivors. Breast Cancer Res Treat 2021; 188:769-778. [PMID: 33797652 PMCID: PMC8277673 DOI: 10.1007/s10549-021-06202-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Racial disparities in cardiovascular disease and cardiac dysfunction exist amongst breast cancer survivors. This study examined the prevalence of cardioprotective medication use in survivors and identified factors associated with use by race. METHODS The analysis included women enrolled in the Women's Hormonal Initiation and Persistence study, a longitudinal observational trial of breast cancer survivors. The study outcome, angiotensin converting enzyme inhibitor (ACEi) or ß-Blocker (BB) use, were ascertained from pharmacy records. Demographic, psychosocial, healthcare, and quality of life factors were collected from surveys and clinical data were abstracted from medical records. Bivariate associations by race and ACEi/BB use were tested using chi square and t tests; logistic regression evaluated multivariable-adjusted associations. RESULTS Of the 246 survivors in the sample, 33.3% were Black and most were < 65 years of age (58.4%). Most survivors were hypertensive (57.6%) and one-third received ACEi/BBs. In unadjusted analysis, White women (vs. Black) (OR 0.33, 95% 0.19-0.58) and women with higher ratings of functional wellbeing (OR 0.94, 95% 0.89-0.99) were less likely to use ACEi/BBs. Satisfaction with provider communication was only significant for White women. In multivariable-adjusted analysis, ACEi/BB use did not differ by race. Correlates of ACEi/BB use included hypertension among all women and older age for Black women only. CONCLUSIONS After adjusting for age and comorbidities, no differences by race in ACEi/BB use were observed. Hypertension was a major contributor of ACEi/BB use in BC survivors.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA.
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Dipankar Bandyopadhyay
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Reuben Retnam
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - William G Hundley
- Department of Internal Medicine, Division of Cardiovascular Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA
- Office of Health Equity and Disparities Research, Massey Cancer Center, Richmond, VA, USA
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Ding H, Sutton AL, Hurtado-de-Mendoza A, Sheppard VB. The role of psychosocial factors in Black women's self-efficacy in receiving genetic counseling and testing. J Genet Couns 2021; 30:1719-1726. [PMID: 34085362 DOI: 10.1002/jgc4.1439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022]
Abstract
Higher self-efficacy in receiving genetic counseling and testing (GCT) has been associated with greater participation in GCT for women at risk of hereditary breast and ovarian cancer (HBOC), but little is known about correlates of self-efficacy in Black women eligible for GCT. The goal of this secondary analysis was to identify sociodemographic and psychosocial factors regarding GCT. Multivariable regression analysis was conducted to assess the relationship between self-efficacy and correlates of interest. Of the 100 Black women surveyed, most women had a college degree (64%), were employed (84%), and had health insurance (93%). In the multivariable model, greater self-efficacy was associated with more positive attitudes toward GCT (Β = 0.126; CI = 0.01 to 0.25; p = 0.039), greater confidence in the Genetic Information Nondiscrimination Act (GINA) (Β = 0.250; CI = 0.04 to 0.46; p = 0.019), and lower ratings of perceived difficulty obtaining GCT (Β = -0.219; CI = -0.46 to -0.10; p = 0.003). Community-level interventions to promote self-efficacy are needed that address perceived barriers to GCT, with the goals of increasing GINA Law awareness in the general public, increasing accessibility to genetic counseling (e.g., telemedicine), and promoting more positive attitudes about GCT.
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Affiliation(s)
- Huanghe Ding
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
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Sharifzadeh Y, Slade AN, Weiss E, Sutton AL, Sheppard VB. Attitudes and Perceptions Towards Radiation Therapy in Breast Cancer Patients: The Role of a Multidisciplinary Care Team. J Cancer Educ 2021; 36:639-645. [PMID: 31940123 PMCID: PMC7543055 DOI: 10.1007/s13187-019-01677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Previous studies have shown that breast cancer patients' beliefs regarding radiation therapy (RT) are influenced by a multitude of factors encompassing demographic, socioeconomic, cultural, and healthcare-related domains. The association between consultation with a multidisciplinary care team and breast cancer patients' attitudes towards RT, however, remains understudied. Using survey and medical record data from 185 women with invasive, non-metastatic breast cancer who received breast conserving surgery, we aimed to characterize the relationship between the number and type of oncological specialties consulted and women's belief in RT's ability to decrease the likelihood of breast cancer recurrence. Using multivariable models, we found that compared to women who discussed RT with only one oncologist (medical, radiation, or surgical), women who discussed RT with all three oncologists were more likely to report increased agreement with RT's ability to reduce cancer recurrence. No single specialty of oncology, including radiation oncology, showed increased associations with women's beliefs regarding RT's efficacy. We conclude that women's beliefs in the ability of radiation therapy to reduce breast cancer recurrence are associated with an increased number of oncologic physicians consulted.
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Affiliation(s)
- Yasamin Sharifzadeh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA
| | - Alexander N Slade
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA.
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College St, Richmond, VA, 23298, USA
| | - Arnethea L Sutton
- Department of Health Behavior & Policy, Virginia Commonwealth University, 401 College St, Richmond, VA, 23298, USA
| | - Vanessa B Sheppard
- Department of Health Behavior & Policy, Virginia Commonwealth University, 401 College St, Richmond, VA, 23298, USA
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Sutton AL, Hagiwara N, Perera RA, Sheppard VB. Assessing Perceived Discrimination as Reported by Black and White Women Diagnosed with Breast Cancer. J Racial Ethn Health Disparities 2021; 8:589-595. [PMID: 32808196 PMCID: PMC7962667 DOI: 10.1007/s40615-020-00817-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although a number of factors contribute to racial disparities in breast cancer outcomes, perceived discrimination in healthcare may be a key factor that hinders positive interactions and negatively impacts patient outcomes. The goals of our study were to (1) assess the prevalence of perceived discrimination as reported by breast cancer patients and (2) identify factors related to discrimination in women overall as well as by race. DESIGN This study is a secondary analysis of a larger study, "Narrowing the Gaps in Adjuvant Therapy," where a convenience sample of 359 women completed one telephone survey assessing sociodemographics, and attitudes and beliefs concerning breast cancer treatments and care. Chi-square analysis was used to assess the relationship of categorical variables with perceived discrimination, while the F-test was employed for continuous variables. Logistic regression determined predictors of perceived discrimination, a dichotomous variable (none vs. any). RESULTS A majority of women were Black (58%), privately insured (85%), and had at least a Bachelor's degree (48%). Discrimination was reported by 32.4% of women, with significantly more Black women reporting discrimination than White women. Insurance status, attitudes toward treatment, and distress factors were significantly related to perceived discrimination. In the logistic model, women who were less trusting of their providers (OR = 0.863 [0.751, 0.993], p = .021) and Black women (OR = 7.241 [0.751, 0.993], p = .039) were more likely to report incidences of discrimination. CONCLUSIONS Our findings suggest a need to understand Black survivor's experiences with healthcare. Similarly, future work must focus on identifying ways to improve provider trust amongst breast cancer survivors.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, P.O. Box 980149, Richmond, VA, 23219, USA.
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, P.O. Box 980149, Richmond, VA, 23219, USA
- Office of Health Equity and Disparities Research, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
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Sutton AL, Preston MA, Thomson M, Litzenberg C, Taylor TF, Cole EP, Sheppard VB. Reaching Rural Residents to Identify Colorectal Cancer Education and Intervention Targets. J Cancer Educ 2021; 36:338-344. [PMID: 31654321 PMCID: PMC7182473 DOI: 10.1007/s13187-019-01635-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Disparities in cancer screening and care in rural communities warrant the need to determine effective ways to reach, engage, and educate the community residents. The purpose of this cross-sectional study was to pilot methods to engage rural residents in colorectal cancer (CRC) research and education activities and assess knowledge of CRC guidelines, symptoms, and screening behaviors in this sample. The community-engaged research approach was employed to develop and distribute a CRC knowledge and screening behavior assessment using various methods such as email and community drop boxes placed throughout the community. Bivariate analysis assessed the relationship between age and CRC knowledge items. Three hundred ninety-one surveys were returned with most received from community drop boxes (60%) followed by educational events (23%). The most ineffective method to distribute surveys was through community events. Most individuals were knowledgeable of CRC symptoms (70%) and screening facts (67%). Bivariate analysis showed that individuals 50 years or older had significantly more knowledge of CRC risks and screening than those under the age of 50. This study highlights the potential of community drop boxes as an effective method for engaging rural communities. Further, findings from the survey highlight the need to focus CRC education on younger individuals in which CRC incidence has increased.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA.
| | - Michael A Preston
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Charlotte Litzenberg
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Trina F Taylor
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Eva Polly Cole
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, MCV Campus, One Capitol Square, 9th floor, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
- Massey Cancer Center, Office of Health Equity and Disparities Research, Virginia Commonwealth University, Richmond, VA, USA
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Sheppard VB, Sutton AL, Hurtado-de-Mendoza A, He J, Dahman B, Edmonds MC, Hackney MH, Tadesse MG. Race and Patient-reported Symptoms in Adherence to Adjuvant Endocrine Therapy: A Report from the Women's Hormonal Initiation and Persistence Study. Cancer Epidemiol Biomarkers Prev 2021; 30:699-709. [PMID: 33514603 PMCID: PMC8330157 DOI: 10.1158/1055-9965.epi-20-0604] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/14/2020] [Accepted: 01/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adjuvant endocrine therapy (AET) improves outcomes in women with hormone receptor-positive (HR+) breast cancer. Suboptimal AET adherence is common, but data are lacking about symptoms and adherence in racial/ethnic minorities. We evaluated adherence by race and the relationship between symptoms and adherence. METHODS The Women's Hormonal Initiation and Persistence study included women diagnosed with nonrecurrent HR+ breast cancer who initiated AET. AET adherence was captured using validated items. Data regarding patient (e.g., race), medication-related (e.g., symptoms), cancer care delivery (e.g., communication), and clinicopathologic factors (e.g., chemotherapy) were collected via surveys and medical charts. Multivariable logistic regression models were employed to calculate odds ratios and 95% confidence intervals (CIs) associated with adherence. RESULTS Of the 570 participants, 92% were privately insured and nearly one of three were Black. Thirty-six percent reported nonadherent behaviors. In multivariable analysis, women less likely to report adherent behaviors were Black (vs. White; OR, 0.43; 95% CI, 0.27-0.67; P < 0.001) and with greater symptom burden (OR, 0.98; 95% CI, 0.96-1.00; P < 0.05). Participants more likely to be adherent were overweight (vs. normal weight) (OR, 1.58; 95% CI, 1.04-2.43; P < 0.05), sat ≤ 6 hours a day (vs. ≥6 hours; OR, 1.83; 95% CI, 1.25-2.70; P < 0.01), and were taking aromatase inhibitors (vs. tamoxifen; OR, 1.91; 95% CI, 1.28-2.87; P < 0.01). CONCLUSIONS Racial differences in AET adherence were observed. Longitudinal assessments of symptom burden are needed to better understand this dynamic process and factors that may explain differences in survivor subgroups. IMPACT Future interventions should prioritize Black survivors and women with greater symptom burden.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
- Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, Virginia
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Jun He
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Megan C Edmonds
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Mary Helen Hackney
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Mahlet G Tadesse
- Department of Mathematics and Statistics, Georgetown University, Washington, DC
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Edmonds MC, Sutton AL, Cummings Y, Sheppard VB. Opportunities to Improve Women's Health: Engaging Racial/Ethnic Diverse Women to Provide Biospecimens for Research. J Womens Health (Larchmt) 2021; 30:1321-1327. [PMID: 33428522 DOI: 10.1089/jwh.2020.8502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective: Inclusion of women in biomedical cancer research have the potential to close gaps in cancer health disparities and improve adjuvant therapies for women; yet samples needed to advance this area of science are lacking. We developed low-cost educational recruitment strategies to increase our collection of biospecimens from women. Materials and Methods: Women diagnosed with hormone receptor positive (HR+) breast cancer that initiated hormonal therapy were recruited from three integrated health systems. The analytical sample (n = 144) consisted of women who consented but did not return a saliva sample within 1 year of the initial assessment (baseline). Brief informational recruitment materials were developed via published literature and preliminary data. Women received recruitment materials, which included a personalized information letter, a colorful low-literacy instruction sheet, a postage-paid envelope, and collection kits. We evaluated intervention materials and performed descriptive and bivariate statistics to describe factors associated with biospecimen donation. Results: Of the total sample, 61% were white and 34% were black. Overall, 29 surveys (20%) and 25 (17%) saliva kits were returned. Women found the materials helpful and easy to read and understand. Women with higher levels of functional well-being and lower ratings of religiosity were more likely to return biospecimens (p < 0.005) after receiving enhanced materials. Conclusion: This article provides recruitment strategies to enhance biospecimen samples among women. Receipt of brief informational print materials inclusive of personalized messages enhanced our outreach strategies and increased our overall biospecimen provision rate by 17%. The inclusion of messages with a focus on spirituality and other cultural messages may further increase biospecimen provision in racial/ethnic diverse groups of women; however, further study is needed to support this claim. Clinical Trail Registration Number: NCT02992730.
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Affiliation(s)
- Megan C Edmonds
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,VCU Massey Cancer Center Office of Health Equity and Disparities Research, Richmond, Virginia, USA
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,VCU Massey Cancer Center Office of Health Equity and Disparities Research, Richmond, Virginia, USA
| | - Yvonne Cummings
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,VCU Massey Cancer Center Office of Health Equity and Disparities Research, Richmond, Virginia, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,VCU Massey Cancer Center Office of Health Equity and Disparities Research, Richmond, Virginia, USA
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Preston MA, Cadet D, Hunley R, Retnam R, Arezo S, Sheppard VB. Abstract PO-018: How to improve health equity and colorectal cancer awareness: A Community Health Educator initiative. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-018] [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
Purpose: Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. As part of the NIH NCI’s long-term outreach and education plan to provide education and increase awareness about cancer risk reduction, the National Outreach Network Community Health Educator (NON-CHE) program was established to reach underserved areas through strong community partnerships. The NON-CHE project identified barriers to CRC screening and implemented the Screen 2 Save (S2S), a national initiative, to increase community knowledge, awareness, and engagement activities. In this study, we assessed the impact of this initiative in rural and underserved communities. Methods: Descriptive and comparative analyses were used to examine the role of the NON-CHE on CRC knowledge and CRC screening intent. Participants included the Massey Cancer Center (MCC) catchment area where 170 surveys were collected from rural and underserved communities. Data included demographics, participants’ current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to participants’ survey scores for CRC knowledge. All analyses were done in R 3.5.2. Results: NON-CHE engaged 441 participants in rural and underserved communities. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p=0.007) more questions on average. After the NON-CHE intervention, this difference was not statistically significant. The difference in participants’ CRC knowledge had an overall mean of 0.92, with a standard deviation of 2.56. Female participants exhibited significantly higher CRC knowledge after controlling for the effect of other demographic variables (p = 0.004). Female study participants also had significantly higher differences between their CRC knowledge scores, exhibiting an average gain in CRC knowledge of 1.08 questions higher than men (p = 0.043). Older participants also tended to demonstrate less improvement – specifically, a one-year increase in participant age corresponded to an adjusted average decrease in improvement of 0.02 questions. Greater than 95% of participants agreed that S2S sessions impacted their intent to get screened for CRC. Conclusions: The NON-CHE facilitated community connections and increased awareness of CRC risk reduction, screening, treatment, and research. Such programs should be considered as mechanisms that increase the knowledge, awareness, and engagement of rural and underserved communities. Equity of access to health information and the health care system can be achieved with precision population health strategies. The NON-CHE combined with S2S is a powerful way to engage rural and underserved communities and impact participants’ intent to “Get Screened”.
Citation Format: Michael A. Preston, Debbie Cadet, Rachel Hunley, Reuben Retnam, Sarah Arezo, Vanessa B. Sheppard. How to improve health equity and colorectal cancer awareness: A Community Health Educator initiative [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-018.
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Affiliation(s)
- Michael A. Preston
- Virginia Commonwealth University, Massey Cancer Center Office of Health Equity & Disparities Research, Richmond, VA
| | - Debbie Cadet
- Virginia Commonwealth University, Massey Cancer Center Office of Health Equity & Disparities Research, Richmond, VA
| | - Rachel Hunley
- Virginia Commonwealth University, Massey Cancer Center Office of Health Equity & Disparities Research, Richmond, VA
| | - Reuben Retnam
- Virginia Commonwealth University, Massey Cancer Center Office of Health Equity & Disparities Research, Richmond, VA
| | - Sarah Arezo
- Virginia Commonwealth University, Massey Cancer Center Office of Health Equity & Disparities Research, Richmond, VA
| | - Vanessa B. Sheppard
- Virginia Commonwealth University, Massey Cancer Center Office of Health Equity & Disparities Research, Richmond, VA
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Sheppard VB, Sutton AL, Retnam R, McGuire KP. Abstract PO-097: Treatment-related toxicities in Black and White women taking adjuvant endocrine therapy. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-097] [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
Purpose: The effectiveness of adjuvant endocrine therapy (AET) to reduce morbidity and mortality among women diagnosed with hormone-receptor positive (HR+) breast cancer (BC) is well understood, yet the potential debilitating toxicities for Black survivors is not. Further, symptom toxicities impact treatment adherence.
Using a mixed methods approach, this study examined patterns of reported AET- related toxicities in HR+ Black and White survivors. Methods: Study participants were enrolled in the Women’s Hormonal Initiation and Persistence study, a longitudinal observational trial of women diagnosed with HR+ breast cancer. Data regarding patient (e.g. race), medication (e.g. AET type), cancer care delivery (e.g. communication), and clinicopathologic factors (e.g., chemotherapy) were collected via surveys and medical charts. The FACT-ES assessed AET toxicity at baseline, 12 and 24 months. Primary analyses focused on the first year; secondary analyses explored changes over time. Multivariable linear regression models examined predictors of AET overall toxicity and for 5 toxicity subgroups. Focus groups with women (N=30) prescribed AET were transcribed verbatim, coded and analyzed. Results: Of the 570 participants, 28% were Black. Black women were more likely to have chemotherapy prior to starting AET but as likely as whites to have radiation. Most women (62%) were taking aromatase inhibitors (AIs). In unadjusted analyses Black women reported more overall, vasomotor, neurological, and gastrointestinal toxicities (p<.05). Race was insignificant in multivariable analysis. Factors associated with higher AET toxicity were higher medication concerns (ß=1.29; CI: 0.88 – 1.69; p<0.001), younger age (ß=-0.23; CI: -0.36 – -0.10; p<0.001), and lower satisfaction with care (ß=-0.24; CI: -0.48 – 0.01; p=0.041). Higher AET gynecological toxicities were associated with AI use (vs. Tamoxifen) (p=0.002) Trends of toxicities over time suggest higher overall reporting by Black women (P=0.07). Qualitative analysis revealed that most women were not prepared for AET toxicities and desired more information at the start of AET. More often than Whites, Black women reported receipt of less information from providers and emphasized that spiritual coping supported their ability to adhere to AET therapy despite toxicities. Conclusion: During the first year of AET, racial disparities in toxicity diminished when controlling for psychosocial and communication factors. Development of interventions that target these factors may enhance symptom management, self-care, and potentially adherence.
Citation Format: Vanessa B. Sheppard, Arnethea L. Sutton, Reuben Retnam, Kandace P. McGuire. Treatment-related toxicities in Black and White women taking adjuvant endocrine therapy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-097.
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Affiliation(s)
- Vanessa B. Sheppard
- 1Virginia Commonwealth University School of Medicine, VCU Massey Cancer Center, Richmond, VA,
| | | | - Reuben Retnam
- 2Virginia Commonwealth University School of Medicine, Richmond, VA,
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Hurtado-de-Mendoza A, Gómez-Trillos S, Graves KD, Carrera P, Campos C, Anderson L, Gronda A, Orellana H, Peshkin BN, Schwartz MD, Cupertino P, Ostrove N, Luta G, Gonzalez N, Sheppard VB. Process evaluation of a culturally targeted video for Latinas at risk of hereditary breast and ovarian cancer. J Genet Couns 2020; 30:730-741. [PMID: 33222313 DOI: 10.1002/jgc4.1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022]
Abstract
This paper presents a process evaluation of a culturally targeted narrative video about hereditary breast and ovarian cancer (HBOC) for Latina women at risk for HBOC. Spanish-speaking Latina women at risk for HBOC participated in a single arm study (n = 40). Participants watched the video developed by the authors and responded to surveys. We used mixed methods to assess theoretical constructs that are hypothesized mediators of narrative interventions (i.e., transportation or engagement, identification with characters, emotions) and implementation outcomes (e.g., acceptability). Descriptive statistics summarized theoretical constructs and implementation outcomes. We conducted Mann-Whitney U tests to assess the differences in theoretical and implementation outcomes between participants who were affected versus. unaffected and participants with different levels of education and health literacy. We used the consensual qualitative research framework to analyze qualitative data. Participants' mean age was 47.1 years (SD = 9.48). Most participants were high school graduates or less (62.5%). Acceptability of the video was extremely high (Md = 10.0, IQR = 0.2, scale 1-10). Most (82.5%) suggested video dissemination be through social media. Participants were highly engaged (Md = 5.7, IQR = 1.5, scale 1-7), strongly identified with the main character (Md = 8.7, IQR = 2.6, scale 1-10), and reported experiencing mostly positive emotions (Md = 9.5, IQR = 2.8, scale 1-10). Participants with low health literacy and affected participants reported a significantly higher identification with the main character (p<.05). Qualitative data reinforced the quantitative findings. Women reported gaining knowledge, correcting misconceptions, and feeling empowered. Our culturally targeted video is highly acceptable and targets mechanisms of behavior change for narrative interventions. The video is easily disseminable and can be used as an education tool for patients including affected and unaffected women and patients with different education and health literacy levels. Future studies should test the impact of the video in enhancing genetic counseling and testing uptake.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Pilar Carrera
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lyndsay Anderson
- School of Nursing, College of Health and Human Services, California State University, Sacramento, CA, USA
| | - Andrés Gronda
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Halyn Orellana
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Beth N Peshkin
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Marc D Schwartz
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Paula Cupertino
- Cancer Prevention and Control Program, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - George Luta
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA.,Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | | | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, Richmond, VA, USA
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Preston MA, Ross L, Chukmaitov A, Smith SA, Odlum ML, Dahman B, Sheppard VB. Health Insurance Coverage Mandates: Colorectal Cancer Screening in the Post-ACA Era. Cancer Prev Res (Phila) 2020; 14:123-130. [PMID: 32917646 DOI: 10.1158/1940-6207.capr-20-0028] [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] [Received: 01/15/2020] [Revised: 07/30/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
Building a culture of precision public health requires research that includes health delivery model with innovative systems, health policies, and programs that support this vision. Health insurance mandates are effective mechanisms that many state policymakers use to increase the utilization of preventive health services, such as colorectal cancer screening. This study estimated the effects of health insurance mandate variations on colorectal cancer screening post Affordable Care Act (ACA) era. The study analyzed secondary data from the Behavioral Risk Factor Surveillance System (BRFSS) and the NCI State Cancer Legislative Database (SCLD) from 1997 to 2014. BRFSS data were merged with SCLD data by state ID. The target population was U.S. adults, age 50 to 74, who lived in states where health insurance was mandated or nonmandated before and after the implementation of ACA. Using a difference-in-differences (DD) approach with a time-series analysis, we evaluated the effects of health insurance mandates on colorectal cancer screening status based on U.S. Preventive Services Task Force guidelines. The adjusted average marginal effects from the DD model indicate that health insurance mandates increased the probability of up-to-date screenings versus noncompliance by 2.8% points, suggesting that an estimated 2.37 million additional age-eligible persons would receive a screening with such health insurance mandates. Compliant participants' mean age was 65 years and 57% were women (n = 32,569). Our findings are robust for various model specifications. Health insurance mandates that lower out-of-pocket expenses constitute an effective approach to increase colorectal cancer screenings for the population, as a whole. PREVENTION RELEVANCE: The value added includes future health care reforms that increase access to preventive services, such as CRC screening, are likely with lower out-of-pocket costs and will increase the number of people who are considered "up-to-date". Such policies have been used historically to improve health outcomes, and they are currently being used as public health strategies to increase access to preventive health services in an effort to improve the nation's health.
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Affiliation(s)
- Michael A Preston
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia. .,Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, VCU Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Levi Ross
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama
| | - Askar Chukmaitov
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Sharla A Smith
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | | | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia.,Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, VCU Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
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Sutton AL, Salgado TM, He J, Hurtado-de-Mendoza A, Sheppard VB. Sociodemographic, clinical, psychosocial, and healthcare-related factors associated with beliefs about adjuvant endocrine therapy among breast cancer survivors. Support Care Cancer 2020; 28:4147-4154. [PMID: 31897782 PMCID: PMC7329595 DOI: 10.1007/s00520-019-05247-5] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/11/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Adjuvant endocrine therapy (AET) reduces the risk of recurrence and mortality in women with hormone receptor-positive breast cancer. However, adherence to AET remains suboptimal. Women's beliefs about medication have been associated with medication adherence. The purpose of this study was to identify multilevel factors associated with women's beliefs about AET. METHODS Beliefs about AET, measured using the Belief about Medicines Questionnaire (BMQ), sociodemographic (e.g., age), psychosocial (e.g., religiosity), and healthcare factors (e.g., patient-provider communication), were collected via survey. Clinical data were abstracted from medical records. Two stepwise regression analyses models were performed to assess relationships between variables and necessity and concern beliefs. RESULTS In our sample of 572 women, mean BMQ concern score was 11.19 and mean necessity score was 13.85 (range 5-20). In the regression models, higher ratings of patient-provider communication were associated with lower concern and higher necessity beliefs. Higher concern beliefs were related to more AET-related symptoms (Β = 0.08; 95% CI 0.06 to 0.10; p < 0.001), lower patient satisfaction (Β = - 0.07; 95% CI - 0.09 to - 0.04; p < 0.001), and higher religiosity (Β = 0.05; 95% CI 0.01 to 0.08; p = 0.007). Higher necessity beliefs were associated with prior chemotherapy use (Β = 0.11; 95% CI 0.06 to 0.16; p < 0.005) and less education (Β = 1.00; 95% CI 0.27 to 1.73; p = 0.008). CONCLUSIONS Modifiable factors are related to women's AET beliefs. Healthcare interactions may play a key role with regard to shaping women's beliefs about their AET medication.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth, University School of Medicine, P.O. Box 980149, Richmond, VA, 23219, USA.
| | - Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth, University School of Pharmacy, Richmond, VA, USA
| | - Jun He
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth, University School of Medicine, P.O. Box 980149, Richmond, VA, 23219, USA
- Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
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Sheppard VB, Dash C, Nomura S, Sutton AL, Franco RL, Lucas A, Ross M, Adams-Campbell L. Physical activity, health-related quality of life, and adjuvant endocrine therapy-related symptoms in women with hormone receptor-positive breast cancer. Cancer 2020; 126:4059-4066. [PMID: 32614992 DOI: 10.1002/cncr.33054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Physical activity (PA) is recommended for women with breast cancer (BC); however, data are sparse on the association of PA with quality of life (QOL) and patient-reported symptoms for women on adjuvant endocrine therapy (AET). METHODS Women with hormone receptor-positive BC who were taking AET completed standardized surveys about their health-related QOL, AET-related symptoms, and levels of PA using validated measures. A Wald chi-square test and an analysis of variance were used to assess associations with PA and independent variables. Generalized linear regression analyses assessed associations between PA, QOL, and AET-related symptoms. RESULTS The analytic cohort included 485 Black and White women. Black race, a high body mass index (BMI), and being on aromatase inhibitors (vs tamoxifen) were associated with lower PA in a bivariate analysis. In a multivariate analysis, lower self-reported PA was associated with a high BMI (P = .02) and chemotherapy uptake (P = .006). Better health-related QOL (P = .01), less severe overall AET-related symptoms (P = .02), and less severe gynecological symptoms (P = .03) were associated with increasing levels of moderate PA. CONCLUSIONS Among women taking AET, moderate levels of PA may be associated with fewer medication-related symptoms and overall better ratings of health-related QOL. Because of the low levels of PA observed in the sample overall and particularly for Black women, identifying successful strategies to promote PA are needed.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia.,Office of Health Equity and Disparities Research, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Chiranjeev Dash
- Department of Oncology, Georgetown University, Washington, DC
| | - Sarah Nomura
- Department of Oncology, Georgetown University, Washington, DC
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Robert Lee Franco
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University College of Humanities and Sciences, Richmond, Virginia
| | - Alexander Lucas
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Masey Ross
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
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Tolsma D, Tadesse MG, Sutton A, Cromwell L, Adunlin G, Salgado TM, He J, Trout M, Robinson BE, Edmonds MC, Bosworth HB, Sheppard VB. Abstract A076: Adherence to adjuvant endocrine therapy: Do racial disparities persist among the insured? Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-a076] [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
Purpose: Adjuvant endocrine therapy (AET) improves survival in women with hormone receptor-positive (HR+) breast cancer (BC). Yet medication adherence is suboptimal. The aim of this study was to assess adherence to AET among insured women using innovative statistical approaches.
Methods: Black and White women diagnosed with HR+ BC were identified from two health maintenance organizations. Automated pharmacy records captured oral AET prescriptions and refill dates. Logistic regression identified predictors of adherence defined in terms of proportion of days covered (PDC) (>=80%) and medication gap of ≤10 days. A zero-inflated negative binominal (ZINB) regression model identified variables associated with the total number of days of medication gaps.
Results: A total of 1,925 women met inclusion criteria. Eighty percent of women were adherent per the PDC measure; 44% had a medication gap of ≤10 days; and 24% of women had zero days without any medication gaps. Race and age were significant predictors of adherence in all multivariable models. Black women were less likely to have PDC >=80% than Whites (OR=0.72; 95%CI: 0.57-0.90; p<0.01), and they were less likely to have a medication gap of ≤10 days (OR=0.65; 95%CI: 0.54-0.79; p<0.001). Women 25-49 years old were less likely to have PDC >=80% than women 65-93 years old (OR=0.65; 95%CI: 0.48-0.87; p<0.001), and they also were less likely to have a medication gap of ≤10 days (OR=0.73; 95%CI: 0.57-0.93; p<0.01). In the zero-inflated negative binominal model, Black women were less likely to having no medication gaps compared to Whites (OR=0.46; 95%CI: 0.54-0.79; p<0.001), and women 25-49 years old were less likely to have no medication gaps compared to women 65-93 years old (OR=0.61; 95%CI: 0.42-0.88; p<0.01).
Conclusions: Disparities in adherence to AET persist among insured women, particularly in Black and young women, highlighting a need for interventions among this population. Novel statistical approaches to study adherence, such as the ZINB approach, appear to constitute a useful alternative to the dichotomous PDC variable to tailor analysis to adherence patterns.
Citation Format: Dennis Tolsma, Mahlet G. Tadesse, Arnethea Sutton, Lee Cromwell, Georges Adunlin, Teresa M. Salgado, Jun He, Martha Trout, Brandi E. Robinson, Megan C. Edmonds, Hayden B. Bosworth, Vanessa B. Sheppard. Adherence to adjuvant endocrine therapy: Do racial disparities persist among the insured? [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A076.
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Affiliation(s)
- Dennis Tolsma
- 1Kaiser Permanente (Georgia) Center for Research and Evaluation, Atlanta, GA,
| | | | - Arnethea Sutton
- 3Virginia Commonwealth University School of Medicine, Richmond, VA,
| | - Lee Cromwell
- 1Kaiser Permanente (Georgia) Center for Research and Evaluation, Atlanta, GA,
| | | | | | - Jun He
- 3Virginia Commonwealth University School of Medicine, Richmond, VA,
| | - Martha Trout
- 6Southeast Permanente Medical Group, Atlanta, GA,
| | - Brandi E. Robinson
- 1Kaiser Permanente (Georgia) Center for Research and Evaluation, Atlanta, GA,
| | - Megan C. Edmonds
- 3Virginia Commonwealth University School of Medicine, Richmond, VA,
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Edmonds MC, Kim SJ, Sheppard VB. Abstract C107: Surveillance mammography and Ffllow-up care in Black and White breast cancer survivors. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-c107] [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
Purpose Adherence to surveillance mammography following a breast cancer (BC) diagnosis is a pivotal way to mitigate late stage BC recurrences and ultimately mortality for breast cancer survivors (BCS); yet there are stark racial disparities in adherence to routine follow-up care post-treatment. This study seeks to address disproportionately low adherence rates to breast surveillance guidelines among Black BCS, when compared to White counterparts, by evaluating environmental, social, and psychosocial factors (e.g., attitudes, knowledge) that may influence survivor’s adherence to surveillance mammography. Methods The mixed method designs involve recruiting and screening Black and White BCS concurrently through an epidemiologic survey and online focus groups via social media platforms (e.g., Facebook, Instagram Quora reddit). Data from survey will employ descriptive and bivariate statistics to assess the relationship between environmental, social and psychosocial factors with surveillance mammography and follow-up care. Guided by the Integrated Behavioral Prediction conceptual framework, thematic and linguistic analyses will be conducted for the online focus group text data to find emergent themes and subthemes. Results This study will provide preliminary results highlighting primary factors (e.g., barriers, facilitators) that influence adherence, by race. Our findings will focus on associated factors for women’s adherence to surveillance mammography, to inform survivorship guidelines and clinical practice. Conclusion Knowledge gained from the study will provide clinicians crucial points of communication; identify important modifiable factors needed in survivorship behavioral interventions, and inform strategies for screening messages. Furthermore, understanding factors that support adherence to surveillance mammography among Black BCS will uncover novel approaches to educate and reach this group in efforts to reduce survival disparities.
Citation Format: Megan C Edmonds, Sunny J Kim, Vanessa B Sheppard. Surveillance mammography and Ffllow-up care in Black and White breast cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C107.
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Affiliation(s)
| | - Sunny J Kim
- Virginia Commonwealth University, Richmond, VA, USA
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Sutton AL, Sheppard VB. Abstract A078: Cause for concern: Understanding Black women's concerns with endocrine therapy. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-a078] [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: Although endocrine therapy (ET) has been shown to improve breast cancer-related outcomes, Black women tend to initiate and adhere to ET at lower rates than White women. Black women also express more concerns about ET when compared to their White counterparts. Beliefs about medication, specifically in regard to concerns about ET, are related to women's decisions to adhere or not adhere to their medication. This study seeks to 1) understand Black women's concerns about ET and 2) identify factors related to black women's concerns about ET.
Methods: This study is part of the Women's Hormonal Initiation and Persistence Study (WHIP), which sought to observe women's patterns of endocrine therapy adherence over time and elucidate factors (e.g., clinical, sociocultural) that relate to medication adherence and discontinuation. Eligible women were at least 21 years of age, diagnosed with hormone receptor-positive (HR+) breast cancer, and initiated endocrine therapy at least 12 months post-diagnosis. Participants completed one telephone or online survey; data also included medical records and pharmacy refill records. This secondary analysis will identify specific concerns about medication as measured by the concern subscale of the beliefs about medicines questionnaire (BMQ) and regression analyses will identify factors (e.g., age, religiosity) related to those concerns. The BMQ concerns scale scores range from 5-20.
Results: A total of 150 Black women were eligible and completed all study activities. A majority (71%) were over the age of 50 and were college educated (81%). All women were insured. Concerns about ET were moderate (m=11.8 SD 3.1). Most women worried about the long-term effects of ET (65.2%). Most women were not concerned that they would become too dependent on ET (83.9%). Bivariate analysis indicates significant relationships between concerns about medication and satisfaction with care (p=0.018), religiosity (p=0.003), provider communication (p=0.013), and education (p=0.035). In the multivariable regression model, Black women who were least satisfied with their care expressed more concerns about ET (p<0.0002). No other factors were selected to the model.
Conclusion: Women's satisfaction with their care impact beliefs about their ET, which may contribute to nonadherence to this life-saving treatment. Further work is needed to fully understand women's ratings of satisfaction with care and how to intervene with women and providers to improve satisfaction and beliefs about ET.
Citation Format: Arnethea L. Sutton, Vanessa B. Sheppard. Cause for concern: Understanding Black women's concerns with endocrine therapy [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A078.
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Edmonds MC, Sutton AL, He J, Perera RA, Sheppard VB. Correlates of Adjuvant Therapy Attitudes in African American Breast Cancer Patients. J Natl Med Assoc 2020; 112:167-175. [PMID: 32197898 DOI: 10.1016/j.jnma.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/11/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Black breast cancer patients delay and underutilize adjuvant breast cancer therapies; yet, very few studies have specifically examined Black women's attitudes toward breast cancer therapy. This study observed the influence of self-reported interpersonal processes of care (e.g. self-efficacy) clinical and sociodemographic factors and sociocultural (e.g. religiosity), related to Black breast cancer patients' attitudes toward radiation and systemic therapies (chemotherapy and adjuvant endocrine therapy - "AET"). METHODS This was a secondary analysis of data from the Narrowing Gaps in Adjuvant Therapy Study (2006-2011). The analysis included 210 Black women who were newly diagnosed with breast cancer. Bivariate and multiple regression analyses were performed between independent variables (e.g., demographics) and three outcome variables (chemotherapy, AET, and radiation therapy) to asses women's perceptions of therapy type. The lasso method was used to select variables correlated with therapy attitudes. RESULTS Most women reported negative attitudes toward AET (56%) and radiation (54%); fewer negative attitudes were observed toward chemotherapy (47%). Higher education and greater perceived susceptibility of a recurrence were associated with more positive attitudes toward chemotherapy. Regarding radiation therapy, women with greater patient satisfaction were more likely to have more positive attitudes. CONCLUSIONS Our study findings may aid in the development of behavioral interventions targeted to mitigate Black women breast cancer treatment disparities. We found modifiable factors (e.g. communication, satisfaction ratings) that support opportunities for clinicians to better address Black women's needs regarding adjuvant treatment options. The development of tailored interventions for newly diagnosed Black breast cancer patients on patient related factors in health care are warranted for Black women with lower educational levels.
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Affiliation(s)
- Megan C Edmonds
- Department of Health Behavior and Policy, USA; VCU Massey Cancer Center Office of Health Equity and Disparities Research, 830 East Main Street, 9th Floor, Richmond, VA, 23219, USA.
| | - Arnethea L Sutton
- Department of Health Behavior and Policy, USA; VCU Massey Cancer Center Office of Health Equity and Disparities Research, 830 East Main Street, 9th Floor, Richmond, VA, 23219, USA
| | - Jun He
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, USA; VCU Massey Cancer Center Office of Health Equity and Disparities Research, 830 East Main Street, 9th Floor, Richmond, VA, 23219, USA
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