Perspectives on cervical cancer screening and prevention: challenges faced by providers and patients along the Texas–Mexico border

Background:

The Rio Grande Valley (RGV) and Laredo regions located along the Texas–Mexico border consist of seven counties with a population of approximately 1.5 million people and a high uninsured rate (33.5%). Cervical cancer mortality in these border counties is approximately 30% higher than the rest of Texas. The RGV and Laredo areas were studied to better understand the state of access to cervical cancer prevention services along the Texas–Mexico border.

Methods:

Data on the population served and the services provided were analyzed to determine the gap between cervical cancer screenings recommended versus those received. Through interviews, we gathered the perspectives of 16 local stakeholders regarding cervical cancer screening for underserved individuals in the region.

Findings:

It is estimated that 69,139 uninsured women aged 21–64 years in the RGV/Laredo per year are recommended to undergo cervical cancer screening with Papanicolaou (Pap) and/or human papillomavirus (HPV) testing, but only 8941 (12.9%) Pap tests are being performed by the Federally Qualified Health Center (FQHC) serving uninsured women in these regions. Systemic barriers identified include insufficient provider clinical capacity, the high cost of healthcare, and uncertainty about government funding sources. Patient barriers identified include inadequate knowledge on navigating the local healthcare system, low health literacy, lack of money and childcare, an inability to miss work, limited transportation, and fear of deportation.

Conclusion:

Decreasing the disparity between cervical cancer screening services provided and those recommended requires addressing the barriers, identified by local experts, which prevent uninsured women from accessing care. These challenges are being addressed through ongoing programs and collaborations.

Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities

Eighty-five percent of the incidents and deaths from cervical cancer occur in low and middle income countries. In many of these countries, this is the most common cancer in women. The survivals of the women with gynecologic cancers are hampered by the paucity of prevention, screening, treatment facilities and gynecologic oncology providers. Increasing efforts dedicated to improving education and research in these countries have been provided by international organizations. We describe here the existing educational and research programs that are offered by major international organizations, the barriers and opportunities provided by these collaborations and hope to improve the outcomes of cervical cancer through these efforts.

Strontium-89 for symptomatic metastatic prostate cancer to bone: recommendations for hospice patients

In our institution, 4 mCi doses of the radiopharmaceutical strontium-89 (Sr89) have been given to 101 prostate cancer patients suffering from symptomatic bone metastases. Patients were prospectively analyzed for pain response, treatment-related hematologic toxicity, and survival. Pre-treatment clinical factors were correlated with outcome. Karnofsky Performance Scores (KPS) predicted for survival and pain response. Myelosuppression from the Sr89 treatment was minimal. Twenty-eight of the treated patients had a KPS of 60 or less. This group of patients had a median actuarial survival of 17.5 weeks, and collectively, met Hospice admission survival criteria. In a subset analysis of this group, patients with a KPS of 50 or less demonstrated a low pain response (40%) and average survival (12.5 weeks), both of which did not appear to justify the significant cost and risk of toxicity associated with Sr89 treatment. In these patients, opioids appeared to offer more cost-effective pain control. Patients with a pre-treatment KPS score of 60 had a mean survival of 20.5 weeks following Sr89 therapy, with 42 percent of patients experiencing a reduction in pain. We conclude that patients with a pretreatment KPS of 50 or less should not be treated with Sr89 and patients with a pretreatment KPS of 60 should be evaluated on a case-by-case basis to determine whether or not Sr89 represents the most reasonable treatment option for palliation of their bone pain.