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Demanelis K, Rosenzweig M, Robertson LB, Low CA, Daniels S, Abujaradeh H, Simon B, Bovbjerg DH, Diergaarde B. Impact of the COVID-19 pandemic on cancer patients in western Pennsylvania: rural-urban disparities. Cancer Causes Control 2023; 34:595-609. [PMID: 37129763 PMCID: PMC10153039 DOI: 10.1007/s10552-023-01696-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE Disparities in cancer care persist between patients living in rural versus urban areas. The COVID-19 pandemic may have impacted concerns related to care and personal health differently in rural cancer patients. Using survey data collected from cancer patients in western Pennsylvania, we examined pandemic-related distress, concerns related to cancer care, impact on personal health, and the extent to which these differed by urban-rural residence. METHODS Patients filled out an initial survey in August-December 2020; a second survey was completed in March 2021. The following patient concerns related to the pandemic were evaluated: threat of COVID-19 to their health, pandemic-related distress, perceptions of cancer care, and vaccine hesitancy. Multivariable logistic regression models were used to examine relationships between these outcomes and urban-rural residence as well as patient-related factors, including anxiety symptoms and social support. RESULTS The study sample included 1,980 patients, 17% resided in rural areas. COVID-19 represented a major or catastrophic threat to personal health for 39.7% of rural and 49.0% of urban patients (p = 0.0017). Patients with high general anxiety were 10-times more likely to experience pandemic-related distress (p < 0.001). In the follow-up survey (n = 983), vaccine hesitancy was twice as prevalent among rural patients compared to urban (p = 0.012). CONCLUSIONS The extent to which perceptions of the threat of COVD-19 to personal health and vaccine hesitancy exacerbates rural-urban disparities in cancer care and prognosis warrants further study. Cancer patients may be vulnerable to heightened anxiety and distress triggered by the pandemic.
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Affiliation(s)
- Kathryn Demanelis
- School of Medicine, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA.
| | - Margaret Rosenzweig
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
- School of Nursing, Department of Acute and Tertiary Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda B Robertson
- School of Medicine, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Carissa A Low
- School of Medicine, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Shayla Daniels
- School of Nursing, Department of Acute and Tertiary Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hiba Abujaradeh
- School of Nursing, Department of Acute and Tertiary Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth Simon
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Dana H Bovbjerg
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brenda Diergaarde
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
- School of Public Health, Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
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Griesemer I, Lightfoot AF, Eng E, Bosire C, Guerrab F, Kotey A, Alexander KM, Baker S, Black KZ, Dixon C, Ellis KR, Foley K, Goettsch C, Moore A, Ryals CA, Smith B, Yongue C, Cykert S, Robertson LB. Examining ACCURE's Nurse Navigation Through an Antiracist Lens: Transparency and Accountability in Cancer Care. Health Promot Pract 2023; 24:415-425. [PMID: 36582178 DOI: 10.1177/15248399221136534] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/31/2022]
Abstract
There are persistent disparities in the delivery of cancer treatment, with Black patients receiving fewer of the recommended cancer treatment cycles than their White counterparts on average. To enhance racial equity in cancer care, innovative methods that apply antiracist principles to health promotion interventions are needed. The parent study for the current analysis, the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, was a system-change intervention that successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. The intervention included specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Community and academic research partners conducted thematic analysis on all clinical notes (n = 3,251) written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162). Analysis was informed by transparency and accountability, principles adapted from the antiracist resource Undoing Racism and determined as barriers to treatment completion through prior research that informed ACCURE. We identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Underlying these themes was a process of enhanced data transparency that allowed navigators to provide tailored patient support. Themes include (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support. Future interventions should incorporate transparency and accountability mechanisms and examine the impact on racial equity in cancer care.
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Affiliation(s)
- Ida Griesemer
- VA Boston Healthcare System, Boston, MA, USA
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | - Alexandra F Lightfoot
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA
| | - Eugenia Eng
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claire Bosire
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fatima Guerrab
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Community-Campus Partnerships for Health, Raleigh, NC
| | - Amanda Kotey
- Alliant Health Solutions, Inc., Atlanta, GA, USA
| | - Kimberly M Alexander
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- The Alexander Group, Durham, NC, USA
- Elon University, Elon, NC, USA
| | - Stephanie Baker
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Elon University, Elon, NC, USA
| | - Kristin Z Black
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- East Carolina University, Greenville, NC, USA
| | - Crystal Dixon
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Wake Forest University, Winston-Salem, NC, USA
| | - Katrina R Ellis
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Karen Foley
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Antionette Moore
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Winston-Salem State University, Winston-Salem, NC, USA
| | - Cleo A Ryals
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cone Health Cancer Center, Greensboro, NC, USA
| | - Beth Smith
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Christina Yongue
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Samuel Cykert
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Stacy SL, Chandra H, Guha S, Gurewitsch R, Brink LAL, Robertson LB, Wilson DO, Yuan JM, Pyne S. Re-scaling and small area estimation of behavioral risk survey guided by social vulnerability data. BMC Public Health 2023; 23:184. [PMID: 36707789 PMCID: PMC9881361 DOI: 10.1186/s12889-022-14970-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/29/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Local governments and other public health entities often need population health measures at the county or subcounty level for activities such as resource allocation and targeting public health interventions, among others. Information collected via national surveys alone cannot fill these needs. We propose a novel, two-step method for rescaling health survey data and creating small area estimates (SAEs) of smoking rates using a Behavioral Risk Factor Surveillance System survey administered in 2015 to participants living in Allegheny County, Pennsylvania, USA. METHODS The first step consisted of a spatial microsimulation to rescale location of survey respondents from zip codes to tracts based on census population distributions by age, sex, race, and education. The rescaling allowed us, in the second step, to utilize available census tract-specific ancillary data on social vulnerability for small area estimation of local health risk using an area-level version of a logistic linear mixed model. To demonstrate this new two-step algorithm, we estimated the ever-smoking rate for the census tracts of Allegheny County. RESULTS The ever-smoking rate was above 70% for two census tracts to the southeast of the city of Pittsburgh. Several tracts in the southern and eastern sections of Pittsburgh also had relatively high (> 65%) ever-smoking rates. CONCLUSIONS These SAEs may be used in local public health efforts to target interventions and educational resources aimed at reducing cigarette smoking. Further, our new two-step methodology may be extended to small area estimation for other locations and health outcomes.
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Affiliation(s)
- Shaina L. Stacy
- grid.478063.e0000 0004 0456 9819UPMC Hillman Cancer Center, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Hukum Chandra
- grid.463150.50000 0001 2218 1322ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India ,Health Analytics Network, Pittsburgh, PA USA
| | - Saurav Guha
- grid.463150.50000 0001 2218 1322ICAR-Indian Agricultural Statistics Research Institute, New Delhi, India ,Health Analytics Network, Pittsburgh, PA USA
| | - Raanan Gurewitsch
- grid.21925.3d0000 0004 1936 9000Public Health Dynamics Lab, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Lu Ann L. Brink
- grid.417890.30000 0004 0413 3898Allegheny County Health Department, Pittsburgh, PA USA
| | - Linda B. Robertson
- grid.478063.e0000 0004 0456 9819UPMC Hillman Cancer Center, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - David O. Wilson
- grid.478063.e0000 0004 0456 9819UPMC Hillman Cancer Center, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Jian-Min Yuan
- grid.478063.e0000 0004 0456 9819UPMC Hillman Cancer Center, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Saumyadipta Pyne
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA. .,Health Analytics Network, Pittsburgh, PA, USA. .,Public Health Dynamics Lab, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Statistics and Applied Probability, University of California Santa Barbara, Santa Barbara, CA, USA.
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Jensen JD, Shannon J, Iachan R, Deng Y, Kim SJ, Demark-Wahnefried W, Faseru B, Paskett ED, Hu J, Vanderpool RC, Lazovich D, Mendoza JA, Shete S, Robertson LB, Balkrishnan R, Briant KJ, Haaland B, Haggstrom DA, Fuemmeler BF. Examining Rural-Urban Differences in Fatalism and Information Overload: Data from 12 NCI-Designated Cancer Centers. Cancer Epidemiol Biomarkers Prev 2022; 31:393-403. [PMID: 35091459 DOI: 10.1158/1055-9965.epi-21-0355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/20/2021] [Revised: 07/01/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rural populations experience a disproportionate cancer burden relative to urban populations. One possibility is that rural populations are more likely to hold counterproductive cancer beliefs such as fatalism and information overload that undermine prevention and screening behaviors. METHODS Between 2016 and 2020, 12 U.S. cancer centers surveyed adults in their service areas using online and in-person survey instruments. Participants (N = 10,362) were designated as rural (n = 3,821) or urban (n = 6,541). All participants were 18 and older (M = 56.97, SD = 16.55), predominately non-Hispanic White (81%), and female (57%). Participants completed three items measuring cancer fatalism ("It seems like everything causes cancer," "There's not much you can do to lower your chances of getting cancer," and "When I think about cancer, I automatically think about death") and one item measuring cancer information overload ("There are so many different recommendations about preventing cancer, it's hard to know which ones to follow"). RESULTS Compared with urban residents, rural residents were more likely to believe that (i) everything causes cancer (OR = 1.29; 95% CI, 1.17-1.43); (ii) prevention is not possible (OR = 1.34; 95% CI, 1.19-1.51); and (iii) there are too many different recommendations about cancer prevention (OR = 1.26; 95% CI, 1.13-1.41), and cancer is always fatal (OR = 1.21; 95% CI, 1.11-1.33). CONCLUSIONS Compared with their urban counterparts, rural populations exhibited higher levels of cancer fatalism and cancer information overload. IMPACT Future interventions targeting rural populations should account for higher levels of fatalism and information overload.
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Affiliation(s)
- Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, Utah.
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jackilen Shannon
- Oregon Health and Science University - Portland State University, School of Public Health, Oregon Health and Science University, Portland, Oregon
| | | | | | - Sunny Jung Kim
- Department of Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences and O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
- University of Kansas Cancer Center, Kansas City, Kansas
| | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, and OSU Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Jinxiang Hu
- University of Kansas Cancer Center, Kansas City, Kansas
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Robin C Vanderpool
- Department of Health, Behavior and Society and Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Jason A Mendoza
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Sanjay Shete
- Department of Biostatistics and Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Linda B Robertson
- School of Medicine and UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajesh Balkrishnan
- Department of Public Health Sciences and UVA Cancer Center, University of Virginia, Charlottesville, Virginia
| | - Katherine J Briant
- Office of Community Outreach and Engagement, Fred Hutch/University of Washington Cancer Consortium, Seattle, Washington
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Sciences, University of Utah, Salt Lake City, Utah
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5
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Black KZ, Lightfoot AF, Schaal JC, Mouw MS, Yongue C, Samuel CA, Faustin YF, Ackert KL, Akins B, Baker SL, Foley K, Hilton AR, Mann-Jackson L, Robertson LB, Shin JY, Yonas M, Eng E. 'It's like you don't have a roadmap really': using an antiracism framework to analyze patients' encounters in the cancer system. Ethn Health 2021; 26:676-696. [PMID: 30543116 PMCID: PMC6565499 DOI: 10.1080/13557858.2018.1557114] [Citation(s) in RCA: 6] [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: 09/20/2017] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
Background: Cancer patients can experience healthcare system-related challenges during the course of their treatment. Yet, little is known about how these challenges might affect the quality and completion of cancer treatment for all patients, and particularly for patients of color. Accountability for Cancer Care through Undoing Racism and Equity is a multi-component, community-based participatory research intervention to reduce Black-White cancer care disparities. This formative work aimed to understand patients' cancer center experiences, explore racial differences in experiences, and inform systems-level interventions.Methods: Twenty-seven breast and lung cancer patients at two cancer centers participated in focus groups, grouped by race and cancer type. Participants were asked about what they found empowering and disempowering regarding their cancer care experiences. The community-guided analysis used a racial equity approach to identify racial differences in care experiences.Results: For Black and White patients, fear, uncertainty, and incomplete knowledge were disempowering; trust in providers and a sense of control were empowering. Although participants denied differential treatment due to race, analysis revealed implicit Black-White differences in care.Conclusions: Most of the challenges participants faced were related to lack of transparency, such that improvements in communication, particularly two-way communication could greatly improve patients' interaction with the system. Pathways for accountability can also be built into a system that allows patients to find solutions for their problems with the system itself. Participants' insights suggest the need for patient-centered, systems-level interventions to improve care experiences and reduce disparities.
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Affiliation(s)
- Kristin Z. Black
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA,
| | - Alexandra F. Lightfoot
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, ,
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | | | - Mary S. Mouw
- Division of Geriatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Christina Yongue
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA,
| | - Cleo A. Samuel
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Yanica F. Faustin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | | | - Barbara Akins
- Behavioral Health, Cone Health System, Greensboro, North Carolina, USA,
| | - Stephanie L. Baker
- Public Health Studies Program, Elon University, Elon, North Carolina, USA,
| | - Karen Foley
- University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,
| | - Alison R. Hilton
- Durham County Department of Public Health, Durham, North Carolina, USA,
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
| | - Linda B. Robertson
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA,
| | - Janet Y. Shin
- Georgia Department of Public Health, Atlanta, Georgia, USA,
| | - Michael Yonas
- Social Innovation, Research and Special Initiatives, The Pittsburgh Foundation, Pittsburgh, Pennsylvania, USA,
| | - Eugenia Eng
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, ,
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Samuel CA, Mbah O, Schaal J, Eng E, Black KZ, Baker S, Ellis KR, Guerrab F, Jordan L, Lightfoot AF, Robertson LB, Yongue CM, Cykert S. The role of patient-physician relationship on health-related quality of life and pain in cancer patients. Support Care Cancer 2019; 28:2615-2626. [DOI: 10.1007/s00520-019-05070-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/02/2019] [Indexed: 01/28/2023]
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Cykert S, Eng E, Manning MA, Robertson LB, Heron DE, Jones NS, Schaal JC, Lightfoot A, Zhou H, Yongue C, Gizlice Z. A Multi-faceted Intervention Aimed at Black-White Disparities in the Treatment of Early Stage Cancers: The ACCURE Pragmatic Quality Improvement trial. J Natl Med Assoc 2019; 112:468-477. [PMID: 30928088 DOI: 10.1016/j.jnma.2019.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 05/23/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reports continue to show that Blacks with curable lung or breast cancer complete treatment less often than similar Whites contributing to worse survival. ACCURE is an intervention trial designed to address this problem. PATIENTS AND METHODS A pragmatic, quality improvement trial comparing an intervention group to retrospective and concurrent controls. Patients with early stage breast or lung cancer aged 18 to 85 were enrolled (N = 302) at 2 cancer centers between April 2013 and March 2015 for the intervention component. Data from patients seen between January 2007 and December 2012 with these diagnoses were obtained to establish control completion rates. Concurrent data for non-study patients were used to identify secular trends. The intervention included: a real time registry derived from electronic health records of participants to signal missed appointments or unmet care milestones, a navigator, and clinical feedback. The primary outcome was "Treatment Complete", a composite variable representing completion of surgery, recommended radiation and chemotherapy for each patient. RESULTS The mean age in the intervention group was 63.1 years; 37.1% of patients were Black. Treatment completion in retrospective and concurrent controls showed significant Black-White differences (Blacks (B) 79.8% vs. Whites (W) 87.3%, p < 0.001; 83.1% B vs. 90.1% W, p < 0.001, respectively). The disparity lessened within the intervention (B 88.4% and W 89.5%, p = 0.77). Multivariate analyses confirmed disparities reduction. OR for Black-White disparity within the intervention was 0.98 (95% CI 0.46-2.1); Black completion in the intervention compared favorably to Whites in retrospective (OR 1.6; 95% CI 0.90-2.9) and concurrent (OR 1.1; 95% CI 0.59-2.0) controls. CONCLUSION A real time registry combined with feedback and navigation improved completion of treatment for all breast and lung cancer patients and narrowed disparities. Similar multi-faceted interventions could mitigate disparities in the treatment of other cancers and chronic conditions.
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Affiliation(s)
- Samuel Cykert
- The University of North Carolina School of Medicine, 145 N Medical Drive CB# 7165, Chapel Hill, NC 27599, USA.
| | - Eugenia Eng
- Department of Health Behavior, The Gilling's School of Global Public Health, 360 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
| | - Matthew A Manning
- Cone Health Cancer Center, 501 N Elam Ave, Greensboro, NC 27403, USA
| | - Linda B Robertson
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine 5150 Centre Avenue POB2 Cancer Pavilion, Room 438 Pittsburgh, PA 15232, USA
| | - Dwight E Heron
- Department of Radiation Oncology UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine5230 Centre Ave. Pittsburgh, PA 15232, USA
| | - Nora S Jones
- The Partnership Project, 301 S. Elm Street, Suite 414 Greensboro, NC 27401, USA
| | - Jennifer C Schaal
- The Partnership Project, 301 S. Elm Street, Suite 414 Greensboro, NC 27401, USA
| | - Alexandra Lightfoot
- Department of Health Behavior, The Gilling's School of Global Public Health 1700 Martin Luther King, Jr. Boulevard CB #7426, Chapel Hill, NC 27599, USA
| | - Haibo Zhou
- Department of Biostatistics, The Gilling's School of Global Public Health, The University of North Carolina at Chapel Hill, 3104C McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC 27599, USA
| | - Christina Yongue
- Department of Public Health Education, University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC 27402-6170, USA
| | - Ziya Gizlice
- Biostatistical Support Unit, The Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill NC 27599, USA
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8
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Vanderpool RC, Huang B, Deng Y, Bear TM, Chen Q, Johnson MF, Paskett ED, Robertson LB, Young GS, Iachan R. Cancer-Related Beliefs and Perceptions in Appalachia: Findings from 3 States. J Rural Health 2019; 35:176-188. [PMID: 30830984 DOI: 10.1111/jrh.12359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/23/2022]
Abstract
BACKGROUND Appalachians experience increased rates of cancer incidence and mortality compared to non-Appalachians. Many factors may contribute to the elevated cancer burden, including lack of knowledge and negative beliefs about the disease. METHODS Three National Cancer Institute (NCI)-designated cancer centers with Appalachian counties in their respective population-based geographic service areas-Kentucky, Ohio, and Pennsylvania-surveyed their communities to better understand their health profiles, including 5 items assessing cancer beliefs. Weighted univariate and bivariate statistics were calculated for each of the 3 state's Appalachian population and for a combined Appalachian sample. Weighted multiple linear regression was used to identify factors associated with a cancer beliefs composite score. Data from the combined Appalachian sample were compared to NCI's Health Information National Trends Survey (HINTS). RESULTS Data from 1,891 Appalachian respondents were included in the analysis (Kentucky = 798, Ohio = 112, Pennsylvania = 981). Significant differences were observed across the 3 Appalachian populations related to income, education, marital status, rurality, perceptions of present income, and body mass index (BMI). Four of 5 cancer beliefs were significantly different across the 3 states. Education, BMI, perceptions of financial security, and Kentucky residence were significantly associated with a lower composite score of cancer beliefs. When comparing the combined Appalachian population to HINTS, 3 of 5 cancer belief measures were significantly different. CONCLUSIONS Variations in cancer beliefs were observed across the 3 states' Appalachian populations. Interventions should be tailored to specific communities to improve cancer knowledge and beliefs and, ultimately, prevention and screening behaviors.
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Affiliation(s)
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | | | - Todd M Bear
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Meghan F Johnson
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Linda B Robertson
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gregory S Young
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Cykert S, Eng E, Walker P, Manning MA, Robertson LB, Arya R, Jones NS, Heron DE. A system-based intervention to reduce Black-White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers. Cancer Med 2019; 8:1095-1102. [PMID: 30714689 PMCID: PMC6434214 DOI: 10.1002/cam4.2005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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: 12/14/2018] [Revised: 12/19/2018] [Accepted: 01/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non-small cell lung cancer. However, racial disparity in survival persists partly because Black patients receive less curative treatment than White patients. METHODS We performed a 5-year pragmatic, trial at five cancer centers using a system-based intervention. Patients diagnosed with early stage lung cancer, aged 18-85 were eligible. Intervention components included: (1) a real-time warning system derived from electronic health records, (2) race-specific feedback to clinical teams on treatment completion rates, and (3) a nurse navigator. Consented patients were compared to retrospective and concurrent controls. The primary outcome was receipt of curative treatment. RESULTS There were 2841 early stage lung cancer patients (16% Black) in the retrospective group and 360 (32% Black) in the intervention group. For the retrospective baseline, crude treatment rates were 78% for White patients vs 69% for Black patients (P < 0.001); difference by race was confirmed by a model adjusted for age, treatment site, cancer stage, gender, comorbid illness, and income-odds ratio (OR) 0.66 for Black patients (95% CI 0.51-0.85, P = 0.001). Within the intervention cohort, the crude rate was 96.5% for Black vs 95% for White patients (P = 0.56). Odds ratio for the adjusted analysis was 2.1 (95% CI 0.41-10.4, P = 0.39) for Black vs White patients. Between group analyses confirmed treatment parity for the intervention. CONCLUSION A system-based intervention tested in five cancer centers reduced racial gaps and improved care for all.
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Affiliation(s)
- Samuel Cykert
- Division of General Medicine and Clinical EpidemiologyThe Center for Health Promotion and Disease PreventionThe Lineberger Cancer CenterThe University of North Carolina School of MedicineThe University of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Eugenia Eng
- Department of Health BehaviorThe Gilling's School of Global Public HealthChapel HillNorth Carolina
| | - Paul Walker
- Leo Jenkins Cancer CenterBrody School of Medicine ‐ East Carolina UniversityGreenvilleNorth Carolina
| | | | | | - Rohan Arya
- Palmetto Health and the University of South Carolina School of MedicineColumbiaSouth Carolina
| | | | - Dwight E. Heron
- Department of Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvania
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Robertson LB. FURTHER OBSERVATIONS ON THE RESULTS OF BLOOD TRANSFUSION IN WAR SURGERY, With Special Reference to the Results in Primary Haemorrhage. Br Med J 2011; 2:679-83. [PMID: 20768816 DOI: 10.1136/bmj.2.2969.679] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morgenlander KH, Winters SB, Lin CJ, Robertson LB, Heron DE, Herberman RB. Novel method for benchmarking recruitment of African American cancer patients to clinical therapeutic trials. J Clin Oncol 2008; 26:5074-7. [PMID: 18809610 PMCID: PMC2737051 DOI: 10.1200/jco.2008.17.3039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 03/24/2008] [Accepted: 06/16/2008] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The National Cancer Institute (NCI) has historically evaluated the participation of underserved minorities within University of Pittsburgh Cancer Institute (UPCI) clinical trials in relation to the proportion of African Americans in the general population of the UPCI primary service area of Allegheny County (12%). This standard seemed to be unrealistically high as a result of a younger age distribution of African Americans within the county. METHODS The proportions of African Americans within the following four separate county populations were compared using data from 2000 to 2004: general population; invasive cancer patients; invasive cancer patients diagnosed or treated at UPCI-affiliated facilities; and patients enrolled onto UPCI's clinical therapeutic trials. RESULTS Although the proportion of African Americans within the general population was approximately 13%, only 9.8% of patients diagnosed with invasive cancers were African American. Approximately 9.5% of all cancer patients diagnosed or treated at UPCI facilities were African American, which is comparable to the county-wide percentage of African American cancer patients. Recruitment rate of African Americans to oncology clinical trials from within the UPCI patient population was 7.6%. The NCI benchmark did not reflect the actual invasive cancer incidence rate in African American patients. By comparing the percentage of African Americans contributing to cancer incidence with the percentage of African American cancer patients treated at research-affiliated institutions, a more appropriate benchmark was derived. CONCLUSION The method developed by UPCI is recommended as a useful mechanism for benchmarking recruitment of African American cancer patients to clinical therapeutic trials at other cancer centers.
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Affiliation(s)
- Keith H Morgenlander
- Department of Hematology/Oncology and Radiation Oncology, University of Pittsburgh School of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232, USA
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Robertson LB. FURTHER OBSERVATIONS ON THE RESULTS OF BLOOD TRANSFUSION IN WAR SURGERY: WITH SPECIAL REFERENCE TO THE RESULTS IN PRIMARY HEMORRHAGE. Ann Surg 2007; 67:1-13. [PMID: 17863834 PMCID: PMC1426720 DOI: 10.1097/00000658-191801000-00001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE The purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB). BACKGROUND SUMMARY: Several independent randomized and sequential studies have reported significantly greater weight loss after RYGB in comparison with VBG. Although the mechanism responsible for weight loss after both procedures is restriction of intake rather than malabsorption, the relationships between calorie intake, food preferences, and postoperative weight loss are not well defined. METHODS During the past 5 years, 138 patients were prospectively selected for either VBG or RYGB, based on their preoperative eating habits. All patients were screened by a dietitian who determined total calorie intake and diet composition before recommending VBG or RYGB. Thirty patients were selected for VBG; the remaining 108 patients were classified as "sweets eaters" or "snackers" and had RYGB. Detailed recall diet histories also were performed at each postoperative visit. RESULTS Early morbidity rate was zero after VBG versus 3% after RYGB. There were no deaths. Mean follow-up was 39 +/- 11 months after VBG and 38 +/- 14 months after RYGB. Mean weight loss peaked at 74 +/- 23 lb at 12 months after VBG and 99 +/- 24 lb at 16 months after RYGB (p < or = 0.001). Twelve of 30 VBG patients lost > or = 50% of their excess weight versus 100 of 108 RYGB patients (p < or = 0.0001). Milk/ice cream intake was significantly greater postoperatively in patients who underwent VBG versus patients who underwent RYGB after 6 months (p < or = 0.003), whereas solid sweets intake was significantly greater after VBG during the first 18 months postoperatively (p < or = 0.004). Revision of VBG was performed in 6 of 30 patients (20%) for complications or poor weight loss, whereas only 2 of 108 patients who underwent RYGB required surgical revisions (p < or = 0.001). CONCLUSIONS These data show that VBG adversely alters postoperative eating behavior toward soft, high-calorie foods, resulting in problematic postoperative weight loss. Conversely, RYGB patients had significantly greater weight loss despite inferior preoperative eating habits. The high rate of surgical revision in conjunction with inconsistent postoperative weight loss has led us to no longer recommend VBG as treatment for morbid obesity.
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Affiliation(s)
- R E Brolin
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick
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Di Raimondo F, Giustolisi R, Cacciola E, O'Brien S, Kantarjian H, Robertson LB, Keating MJ. Autoimmune hemolytic anemia in chronic lymphocytic leukemia patients treated with fludarabine. Leuk Lymphoma 1993; 11:63-8. [PMID: 8220155 DOI: 10.3109/10428199309054731] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Autoimmune hemolytic anemia (AHA) is a frequent complication of chronic lymphocytic leukemia (CLL). Although the pathogenesis of AHA is still unknown, an imbalance of normal residual T cells is believed to play a central role. Since fludarabine is reported to affect primarily T lymphocytes, we conducted a retrospective study to evaluate the incidence and outcome of AHA in 112 CLL patients treated with fludarabine alone. Eight patients had AHA before therapy; only one achieved remission of both CLL and AHA after fludarabine alone. In the other seven patients, we observed no effect or even a worsening of AHA, although the CLL was responding to fludarabine. Five patients developed AHA from 1 to 19 months after fludarabine therapy while the CLL was responding. One additional patient developed pure red cell aplasia (PRCA) 3 months after starting therapy. Most patients in both groups responded to steroids or other immunosuppressive therapy. The study showed that in these patients, AHA evolved independently of CLL and was not affected by fludarabine.
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- CD4-CD8 Ratio
- Coombs Test
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
- Retrospective Studies
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- F Di Raimondo
- Institute of Hematology, University of Catania, Italy
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Keating MJ, O'Brien S, Kantarjian H, Robertson LB, Koller C, Beran M, Estey E. Nucleoside analogs in treatment of chronic lymphocytic leukemia. Leuk Lymphoma 1993; 10 Suppl:139-45. [PMID: 8097653 DOI: 10.3109/10428199309149126] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The nucleoside analogs fludarabine monophosphate, 2-chlorodeoxyadenosine, and 2-deoxycoformycin (pentostatin) all have activity in chronic lymphocytic leukemia. The most widely studied drug is fludarabine which is able to obtain complete or partial responses in more than 50% of previously treated patients. The response rate is 44% for 2-CDA and approximately 25% for pentostatin. Fludarabine has also been used to treat patients as initial therapy, and has resulted in overall response rate of 79% with 75% of the patients achieving complete remission. The NCI and International Working Group for CLL criteria for complete remission allow for persistent nodules or lymphoid infiltrates in the bone marrow biopsy. Studies have now demonstrated persistent lymphoid aggregates are associated with a shorter time to progression for responders but no survival disadvantage. There is a strong association of documented refractoriness to alkylating agents with probability of response to fludarabine and also survival. The major morbidity associated with the use of these drugs are infections, which, in some circumstances, are associated with neutropenia but in other circumstances are probably related to the hypogammaglobulinemia and T-cell immunodeficiency which are part of the disease. The T-cell immunodeficiency is aggravated by the nucleoside analogs. Even after discontinuation of therapy the immunodeficiency as measured by CD4 cell number is sustained for 12 to 24 months. Opportunistic organisms such as herpes simplex, herpes zoster, Listeria monocytogenes, and pneumocystis carinii are being noted in patients treated with these agents. The potency of these drugs and low incidence of toxicities to other organs suggests that they will be effectively combined with other agents.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M J Keating
- Department of Hematology, University of Texas M.D. Anderson Medical Center, Houston 77030
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Robertson LB. Traumatic rupture of the jejunum: Operation-Recovery. Can Med Assoc J 1918; 8:235-237. [PMID: 20311076 PMCID: PMC1585109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Gallie WE, Robertson LB. Pyloric Stenosis in Infants. Can Med Assoc J 1917; 7:1-9. [PMID: 20310888 PMCID: PMC1584788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Robertson LB. Carcinoma of the Breast in a Man with Apparently Healed Miliary Tuberculosis. Can Med Assoc J 1915; 5:46-48. [PMID: 20310591 PMCID: PMC1486266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Robertson LB. TRAUMATIC ASPHYXIA WITH A REPORT OF SIX CASES. Can Med Assoc J 1914; 4:501-507. [PMID: 20310500 PMCID: PMC406657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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