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Gudina AT, Kamen C, Hardy SJ, Kehoe L, Culakova E, Cupertino AP. Revisiting the lung cancer screening eligibility criteria to promote equity for Black individuals. Lung Cancer 2024; 191:107539. [PMID: 38552545 DOI: 10.1016/j.lungcan.2024.107539] [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: 12/13/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Early detection using low-dose computed tomography reduces lung-cancer-specific mortality by 20% among high-risk individuals. Blacks are less likely than Whites to meet lung cancer screening (LCS) criteria under both the former and the updated United States Preventive Services Task Force (USPSTF) guidelines. The purpose of this study was to assess racial disparities in LCS eligibility and to propose tailored eligibility criteria for Blacks to enable equitable screening rate between Whites and Blacks. METHODS Data for this study were obtained from the Behavioral Risk Factor Surveillance System (2017-2021). 101,552 subjects were included in the final analysis. By employing a systematic approach, we sought cut-off points at which Blacks were equally likely as Whites to be eligible for LCS. We evaluated the minimum age and smoking pack-years for Blacks while we retained the 2021 USPSTF criteria for Whites. The final decision was based on the minimum Wald's Chi-square statistics. RESULTS The model we employed identified cut-off points at which Blacks were equally likely as Whites to be eligible for LCS. Retaining the 2021 USPSTF criteria for Whites, the model discovered a new pair of points for Blacks by reducing the minimum age to 43 years and decreasing the cumulative number of cigarettes smoked to 15 pack-years. Based on these cut-off points, we created tailored criteria for Blacks. Under the tailored criteria, Blacks (OR: 1.00; 95 %CI: 0.88-1.14) had the same odds of eligibility for LCS as Whites. The odds of eligibility for LCS by sex under the tailored criteria did not differ significantly for Black men (OR: 1.02; 95 %CI: 0.85-1.24) and Black women (OR: 0.95; 95 %CI: 0.81-1.12) compared to their respective White counterparts. CONCLUSIONS These tailored criteria for Blacks eliminate the disparities between Blacks and Whites in LCS eligibility. Future studies should test the sensitivity and specificity of these tailored criteria.
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Affiliation(s)
- Abdi T Gudina
- Department of Public Health Sciences at the University of Rochester, School of Medicine and Dentistry, NY, United States.
| | - Charles Kamen
- Division of Supportive Care in Cancer in the Department of Surgery at the University of Rochester, School of Medicine and Dentistry and the James P. Wilmot Cancer Institute at the University of Rochester, School of Medicine and Dentistry, NY, United States
| | - Sara J Hardy
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States; Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - Lee Kehoe
- Division of Supportive Care in Cancer in the Department of Surgery at the University of Rochester, School of Medicine and Dentistry and the James P. Wilmot Cancer Institute at the University of Rochester, School of Medicine and Dentistry, NY, United States
| | - Eva Culakova
- Division of Supportive Care in Cancer in the Department of Surgery at the University of Rochester, School of Medicine and Dentistry and the James P. Wilmot Cancer Institute at the University of Rochester, School of Medicine and Dentistry, NY, United States
| | - Ana-Paula Cupertino
- Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States
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Rivera MP, Gudina AT, Cartujano-Barrera F, Cupertino P. Disparities Across the Continuum of Lung Cancer Care. Clin Chest Med 2023; 44:531-542. [PMID: 37517833 DOI: 10.1016/j.ccm.2023.03.009] [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] [Indexed: 08/01/2023]
Abstract
Despite the overall decline in lung cancer incidence and mortality, minority populations continue to bear a higher disease burden. Lung cancer remains the leading cause of cancer-related death in the United States and disproportionately impacts minority populations. Social determinants of health-including low-socioeconomic status, lack of health insurance, and access to health care- disproportionately impact racial, ethnic, and rural populations resulting in direct consequences on lung cancer disparities.
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Affiliation(s)
- M Patricia Rivera
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY 14642, USA.
| | - Abdi T Gudina
- University of Rochester Medical Center, 265 Crittenden Boulevard, Rm 2-223, Rochester, NY 14642, USA
| | | | - Paula Cupertino
- University of Rochester Medical Center, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA
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Gudina AT, Kamen C, Cheruvu VK, Cupertino P, Rivera MP. Understanding Factors Associated with Uptake of Lung Cancer Screening among Individuals at High Risk. J Health Care Poor Underserved 2023; 34:719-730. [PMID: 37464528 DOI: 10.1353/hpu.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Early detection using low-dose computed tomography scanning reduces lung cancer-specific mortality by 20% among high-risk individuals. Despite its efficacy, the uptake of lung cancer screening (LCS) remains low. This study aimed to identify factors associated with the uptake of LCS in high-risk individuals. Data for this study were obtained from the Behavioral Risk Factor Surveillance System (n=11,297). Multivariable logistic regression models were used. Individuals with no health insurance (OR: 0.33, 95% CI: 0.19-0.58), no primary health care provider (OR: 0.40, 95% CI: 0.25-0.64), no chronic obstructive pulmonary disease (OR: 0.37, 95% CI: 0.28- 0.49), and racial/ethnic minorities other than Black and Hispanic (OR: 0.49, 95% CI: 0.31-0.78) were less likely to participate in annual LCS. Low-dose computed tomography uptake varied widely across the 24 U.S. states. The findings from this study have important implications for designing more effective interventions to target specific U.S. states and subgroups for the uptake of annual LCS.
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Kleckner AS, Kleckner IR, Culakova E, Shayne M, Belcher EK, Gudina AT, Williams AM, Onitilo AA, Hopkins JO, Gross H, Mustian KM, Peppone LJ, Janelsins MC. The association between cancer-related fatigue and diabetes from pre-chemotherapy to 6 months post-chemotherapy. Support Care Cancer 2022; 30:7655-7663. [PMID: 35678881 PMCID: PMC10079326 DOI: 10.1007/s00520-022-07189-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To quantify the relationship between diabetes and fatigue from pre-chemotherapy to 6 months post-chemotherapy for women with breast cancer compared to women without a history of cancer (controls). METHODS This was a secondary analysis from a nationwide prospective longitudinal study of female patients with breast cancer undergoing chemotherapy and controls. Diabetes diagnosis (yes/no) was obtained at baseline, and cancer-related fatigue was measured using the Multidimensional Fatigue Symptom Inventory (MFSI) pre-, post-, and 6 months post-chemotherapy in patients; controls were assessed at equivalent time points. Repeated measures mixed effects models estimated the association between fatigue and diabetes controlling for cancer (yes/no), body mass index, exercise and smoking habits, baseline anxiety and depressive symptoms, menopausal status, marital status, race, and education. RESULTS Among 439 patients and 235 controls (52.8 ± 10.5 years old), diabetes was twice as prevalent among patients as controls (11.6% vs. 6.8%). At baseline, diabetes was associated with worse fatigue (4.1 ± 1.7 points, p = 0.017). Also, diabetes was associated with clinically meaningful worse fatigue throughout the study period among all participants (5.2 ± 1.9 points, p = 0.008) and patients alone (4.5 ± 2.0, p = 0.023). For the MFSI subdomains among patients, diabetes was associated with worse general (p = 0.005) and mental fatigue (p = 0.026). CONCLUSIONS Diabetes was twice as prevalent in women with breast cancer compared to controls, and diabetes was associated with more severe cancer-related fatigue in patients before and after chemotherapy and at 6 months post-chemotherapy. Interventions that address diabetes management may also help address cancer-related fatigue during chemotherapy treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01382082, first posted June 27, 2011.
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Affiliation(s)
- Amber S Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, 655 W. Lombard Ave., 7th floor, Baltimore, MD, 21201, USA.
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, 655 W. Lombard Ave., 7th floor, Baltimore, MD, 21201, USA
| | - Eva Culakova
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle Shayne
- Department of Medicine, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420658, Rochester, NY, 14642, USA
| | - Elizabeth K Belcher
- Department of Psychological Science, Hobart and William Smith Colleges, Geneva, NY, USA
| | - Abdi T Gudina
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - AnnaLynn M Williams
- Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Judith O Hopkins
- Southeast Clinical Oncology Research (SCOR) Consortium, Winston-Salem, Weston, NC, USA
| | - Howard Gross
- Dayton Clinical Oncology Program, Dayton, OH, USA
| | - Karen M Mustian
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Luke J Peppone
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle C Janelsins
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
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Gudina AT, Cheruvu VK, Gilmore NJ, Kleckner AS, Arana-Chicas E, Kehoe LA, Belcher EK, Cupertino AP. Health related quality of life in adult cancer survivors: Importance of social and emotional support. Cancer Epidemiol 2021; 74:101996. [PMID: 34333220 PMCID: PMC10079325 DOI: 10.1016/j.canep.2021.101996] [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: 12/30/2020] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adult cancer survivors (ACS) are at increased risk for developing various comorbid conditions and having poor health-related quality of life (HRQOL) when compared to adults with no history of cancer. The effect of social and emotional support on HRQOL among ACS is not fully elucidated. The purpose of this study was to understand the role of social and emotional support on HRQOL in ACS and to examine if the association between social and emotional support and HRQOL is modified by gender, time since cancer diagnosis, or marital status. METHODS Data for this study were obtained from the 2009 Behavioral Risk Factor Surveillance System. Statistical analysis was based on ACS with complete data (n = 23,939) on all variables considered. Multivariable logistic regression models were used to model the association between social and emotional support and indicators of HRQOL (i.e., general health, physical health, mental health, and activity limitation). To examine if gender, marital status, or the number of years since cancer diagnosis modify the association, separate stratified analyses were conducted. RESULTS When compared to ACS who reported that they Rarely/Never received social and emotional support, those who reported that they Always received were 32 % less likely to report Fair/Poor General health, 23 % less likely to report frequent unhealthy days of Physical health, 73 % less likely to report frequent unhealthy days of Mental health and 38 % less likely to report frequent unhealthy days of Activity limitation. Social and emotional support was positively associated with all four domains of HRQOL among ACS who were female, unmarried, or greater than 5 years since cancer diagnosis, while this positive association was evident only with one or two domains of HRQOL among their corresponding counterparts (i.e., male, married, less than 5 years since diagnosis). CONCLUSIONS Social and emotional support is an important factor directly related to a better HRQOL, but it is modified by gender, marital status, and time since diagnosis. Findings from this study should inform health care providers about the importance of a support system for ACS in improving their overall quality of life.
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Affiliation(s)
- Abdi T Gudina
- Division of Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester Cancer Center NCI Community Oncology Research Program (NCORP), USA
| | - Vinay K Cheruvu
- Dvision of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, USA.
| | - Nikesha J Gilmore
- Division of Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester Cancer Center NCI Community Oncology Research Program (NCORP), USA
| | - Amber S Kleckner
- Division of Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester Cancer Center NCI Community Oncology Research Program (NCORP), USA
| | - Evelyn Arana-Chicas
- Division of Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester Cancer Center NCI Community Oncology Research Program (NCORP), USA
| | - Lee A Kehoe
- Division of Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester Cancer Center NCI Community Oncology Research Program (NCORP), USA
| | - Elizabeth K Belcher
- Division of Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester Cancer Center NCI Community Oncology Research Program (NCORP), USA
| | - Ana Paula Cupertino
- Division of Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester Cancer Center NCI Community Oncology Research Program (NCORP), USA
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Gudina AT, Copeland G, Soliman A, Hirko KA. Abstract C106: Racial/ethnic disparities in inflammatory breast cancer survival in the Michigan Cancer Surveillance Program. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c106] [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: Inflammatory breast cancer (IBC) is the most aggressive form of breast cancer, largely due to its strong metastatic potential. The lack of a standard case definition for IBC over time, coupled with the fact that IBC is a relatively rare disease, has severely limited our understanding of the disease. While racial disparities in IBC incidence are fairly well documented, with black women having significantly higher IBC rates compared to white women, less is known about whether IBC prognosis differs by race/ethnicity. Therefore, the objective of this study was to utilize a comprehensive case definition of IBC to assess racial/ethnic disparities in survival in the Michigan Cancer Surveillance Program (MCSP) from 1998 to 2014.
Methods: Using a comprehensive case definition of IBC, 1,324 IBC patients were identified from women diagnosed with invasive breast cancer in the MCSP between 1998 and 2014 with information on survival time and race/ethnicity (non-Hispanic Black (NHB)=227; non-Hispanic White (NHW)=984; Hispanic =86; other =27). We examined the frequency and percentage of breast cancer cases coded to the various IBC codes in the MCSP registry over the study period. We used age-adjusted and multivariable Cox proportional hazard regression models with age as the underlying time metric to estimate hazard ratios (HR) and 95% confidence interval (CI) for associations of race/ethnicity with all-cause mortality, using NHW women as the reference group.
Results: The percentage of all breast cancer cases defined as IBC in the MCSP registry differs considerably across registry codes from 0.03% to 1.2%. We observed significantly higher risk of death among NHB compared with NHW (HR (95% CI), 1.21 (1.01-1.45)), while no significant survival differences were observed between NHW and Hispanics or other racial/ethnic minorities.
Conclusions: A comprehensive case definition should be utilized to avoid underestimation of IBC and to better understand this aggressive disease. Further research is needed to identify underlying causes and develop effective interventions to reduce survival disparities in IBC.
Citation Format: Abdi T. Gudina, Glenn Copeland, Amr Soliman, Kelly A. Hirko. Racial/ethnic disparities in inflammatory breast cancer survival in the Michigan Cancer Surveillance Program [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 C106.
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Affiliation(s)
| | | | - Amr Soliman
- 3Medical School of the City University of New York, New York, NY,
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Cheruvu VK, Odhiambo LA, Mowls DS, Zullo MD, Gudina AT. Health-related quality of life in current smokers with COPD: factors associated with current smoking and new insights into sex differences. Int J Chron Obstruct Pulmon Dis 2016; 11:2211-2219. [PMID: 27695308 PMCID: PMC5029840 DOI: 10.2147/copd.s106207] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Findings from studies that examined the association between health-related quality of life (HRQOL) and smoking status among COPD patients have been mixed. Moreover, factors associated with current smoking in COPD patients and differences by sex have not been fully elucidated. Data from the 2011 and 2012 Behavioral Risk Factor Surveillance System was used in this study. Four HRQOL indicators were examined in this study: general health, physical health, mental health, and activity limitations. General health was dichotomized into two groups: “excellent/very good/good” and “fair/poor”, and the other three HRQOL indicators were dichotomized into <14 (infrequent) and ≥14 (frequent) unhealthy days in the past 30 days. To examine HRQOL indicators in association with current versus former smoking and identify factors associated with current smoking, logistic regression models were used. Sex differences were explored. In COPD patients, current smokers compared to former smokers had significantly poor HRQOL on all subdomains: “fair/poor” general health (adjusted odds ratio [AOR]: 1.2 [95% confidence interval {CI}: 1.1–1.5]); poor physical health (AOR: 1.3 [CI: 1.1–1.5]); poor mental health (AOR: 1.8 [CI: 1.4–2.2]); and poor activity limitations (AOR: 1.5 [CI: 1.3–1.9]). HRQOL subdomains affected by current smoking differed by sex except activity limitations. General health (AOR: 1.5 [CI: 1.1–2.0]) and activity limitations (AOR: 1.6 [95% CI: 1.2–2.2]) in males and physical health (AOR: 1.3 [CI: 1.0–1.6]), mental health (AOR: 2.1 [CI: 1.7–2.6]), and activity limitations (AOR: 1.5 [CI: 1.2–1.9]) in females were significantly impaired due to current smoking. Factors associated with current smoking differed by sex except being unmarried and having less than a college degree, which were associated with current smoking in both males and females. These findings have important implications for health care providers in designing more effective interventions which tailor to and target specific subgroups for smoking cessation.
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Affiliation(s)
- Vinay K Cheruvu
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH
| | - Lorriane A Odhiambo
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH
| | - Dana S Mowls
- Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Melissa D Zullo
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH
| | - Abdi T Gudina
- Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH
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