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Gilmore N, Grant SJ, Bethea TN, Schiaffino MK, Klepin HD, Dale W, Hardi A, Mandelblatt J, Mohile S. A scoping review of racial, ethnic, socioeconomic, and geographic disparities in the outcomes of older adults with cancer. J Am Geriatr Soc 2024. [PMID: 38593225 DOI: 10.1111/jgs.18881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Cancer health disparities are widespread. Nevertheless, the disparities in outcomes among diverse survivors of cancer ages 65 years and older ("older") have not been systematically evaluated. METHODS We conducted a scoping review of original research articles published between January 2016 and September 2023 and indexed in Medline (Ovid), Embase, Scopus, and CINAHL databases. We included studies evaluating racial, ethnic, socioeconomic disadvantaged, geographic, sexual and gender, and/or persons with disabilities disparities in treatment, survivorship, and mortality among older survivors of cancer. We excluded studies with no a priori aims related to a health disparity, review articles, conference proceedings, meeting abstracts, studies with unclear methodologies, and articles in which the disparity group was examined only as an analytic covariate. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. RESULTS After searching and removing duplicates, 2573 unique citations remained and after screening 59 articles met the inclusion criteria. Many investigated more than one health disparity, and most focused on racial and ethnic (n = 44) or socioeconomic (n = 25) disparities; only 10 studies described geographic disparities, and none evaluated disparities in persons with disabilities or due to sexual and gender identity. Research investigating disparities in outcomes among diverse older survivors of cancer is increasing gradually-68% of eligible articles were published between 2020 and 2023. Most studies focused on the treatment phase of care (n = 28) and mortality (n = 26), with 16 examined disparities in survivorship, symptoms, or quality of life. Most research was descriptive and lacked analyses of potential underlying mechanisms contributing to the reported disparities. CONCLUSION Little research has evaluated the effect of strategies to reduce health disparities among older patients with cancer. This lack of evidence perpetuates cancer inequities and leaves the cancer care system ill equipped to address the unique needs of the rapidly growing and increasingly diverse older adult cancer population.
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Affiliation(s)
- Nikesha Gilmore
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, New York, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research and the Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Melody K Schiaffino
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, USA
| | - Heidi D Klepin
- Department of Hematology and Oncology, Comprehensive Cancer Center, Wake Forest University, Winston Salem, North Carolina, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeanne Mandelblatt
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Supriya Mohile
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
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Halbert CH. Social Drivers of Cancer Risk and Outcomes Among African American Men. Cancer J 2023; 29:293-296. [PMID: 37963361 PMCID: PMC10914063 DOI: 10.1097/ppo.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Social risk factors play an important role in minority health and cancer health disparities. Exposure to stress and stress responses are important social factors that are now included in conceptual models of cancer health disparities. This report summarizes results from studies that examined stress exposure and responses among African Americans. Data from studies that were conducted as part of a transdisciplinary and translational research center are also presented to provide additional insight about the nature of racial differences in specific stressors among African American and White prostate cancer patients.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles CA 90089
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089
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3
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Wang C, Bertrand KA, Trevino-Talbot M, Flynn M, Ruderman M, Cabral HJ, Bowen DJ, Hughes-Halbert C, Palmer JR. Ethical, legal, and social implications (ELSI) and challenges in the design of a randomized controlled trial to test the online return of cancer genetic research results to U.S. Black women. Contemp Clin Trials 2023; 132:107309. [PMID: 37516165 PMCID: PMC10544717 DOI: 10.1016/j.cct.2023.107309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/27/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND A central challenge to precision medicine research efforts is the return of genetic research results in a manner that is effective, ethical, and efficient. Formal tests of alternate modalities are needed, particularly for racially marginalized populations that have historically been underserved in this context. METHODS We are conducting a randomized controlled trial (RCT) to test scalable modalities for results return and to examine the clinical utility of returning genetic research results to a research cohort of Black women. The primary aim is to compare the efficacy of two communication modalities for results return: 1) a conventional modality that entails telephone disclosure by a Board-certified genetic counselor, and 2) an online self-guided modality that entails results return directly to participants, with optional genetic counselor follow-up via telephone. The trial is being conducted among participants in the Black Women's Health Study (BWHS), where targeted sequencing of 4000 participants was previously completed. RESULTS Several ethical, legal, and social implications (ELSI) and challenges presented, which necessitated substantial revision of the original study protocol. Challenges included chain of custody, re-testing of research results in a CLIA lab, exclusion of VUS results, and digital literacy. Bioethical principles of autonomy, justice, non-maleficence, and beneficence were considered in the design of the study protocol. CONCLUSION This study is uniquely situated to provide critical evidence on the effectiveness of alternative models for genetic results return and provide further insight into the factors influencing access and uptake of genetic information among U.S. Black women. CLINICALTRIALS gov: NCT04407611.
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Affiliation(s)
- Catharine Wang
- Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Kimberly A Bertrand
- Slone Epidemiology Center at Boston University, 72 East Concord St, L-7, Boston, MA 02118, USA.
| | | | - Maureen Flynn
- MGH Institute of Health Professions, 36 1st Ave, Boston, MA 02129, USA.
| | - Maggie Ruderman
- Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St, Boston, MA 02118, USA.
| | - Howard J Cabral
- Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA.
| | - Deborah J Bowen
- University of Washington, 1959 NE Pacific Street, Box 357120, Seattle, WA 98195, USA.
| | - Chanita Hughes-Halbert
- University of Southern California, 1845 North Soto Street, MC 9C 9239, Los Angeles, CA 90089, USA.
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, 72 East Concord St, L-7, Boston, MA 02118, USA; Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St, Boston, MA 02118, USA.
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4
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Esperto F, Cacciatore L, Tedesco F, Brassetti A, Testa A, Raso G, Iannuzzi A, Papalia R, Scarpa RM. Video Consensus and Radical Prostatectomy: The Way to Chase the Future? J Pers Med 2023; 13:1013. [PMID: 37374002 DOI: 10.3390/jpm13061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/16/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
In the age of information, new platforms are consulted by patients to acquire consciousness about medical treatments. The aim of this study was to assess the level of understanding and feasibility of video consensus (VC) administration in patients scheduled for radical prostatectomy (RP), comparing it with standard informed consensus (SIC). According to the European Association of Urology Patient Information, we set up a video content for RP that was translated in Italian and implemented with information about possible perioperative and postoperative complications, days of hospitalization etc. From 2021 to 2022, all patients undergoing RP at our institution were prospectively included in this study. Patients received an SIC and after that, a VC about RP. After two consensuses were administered, patients received a preformed Likert 10 scale and STAI questionnaires. On the RP dataset, 276 patients were selected and 552 questionnaires for both SIC and VC were evaluated. Out of these, the median age was 62 years (IQR 60-65). Patients reported a higher overall satisfaction for VC (8.8/10) compared to the traditional informed consent (6.9/10). Therefore, VC may play a role in the future of surgery, improving the consciousness and satisfaction of patients and reducing preoperative anxiety.
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Antonio Testa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Gianluigi Raso
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
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5
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Hughes Halbert C. Social Determinants of Health and Cancer Care: Where Do We Go From Here? J Natl Cancer Inst 2022; 114:1564-1566. [PMID: 36073955 PMCID: PMC9745423 DOI: 10.1093/jnci/djac175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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6
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Jiang H, Lyu J, Mou W, Jiang Q, Du J. Association between financial toxicity and health‐related quality of life in cancer survivors: A systematic review. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/19/2022] [Accepted: 10/30/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Hua Jiang
- School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Jianxia Lyu
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Wenxuan Mou
- School of Nursing Chengdu Medical College Chengdu China
| | - Qinghua Jiang
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Jiali Du
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center School of Medicine University of Electronic Science and Technology of China Chengdu China
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7
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Joyce DD, Wallis CJD, Huang LC, Hoffman KE, Zhao Z, Koyama T, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Kaplan SH, Greenfield S, Penson DF, Barocas DA. The Association Between Financial Toxicity and Treatment Regret in Men With Localized Prostate Cancer. JNCI Cancer Spectr 2022; 6:6762868. [PMID: 36255249 PMCID: PMC9731205 DOI: 10.1093/jncics/pkac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Financial toxicity is emerging as an important patient-centered outcome and is understudied in prostate cancer patients. We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better evaluate the role of financial discussions in patient counseling. METHODS Utilizing the Comparative Effectiveness Analysis of Surgery and Radiation dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance for localized prostate cancer. Financial burden and treatment regret were assessed at 3- and 5-year follow-up. The association between financial burden and regret was assessed using multivariable longitudinal logistic regression controlling for demographic and disease characteristics, treatment, functional outcomes, and patient expectations. RESULTS Of the 2924 eligible patients, regret and financial burden assessments for 3- and/or 5-year follow-up were available for 81% (n = 2359). After adjustment for relevant covariates, financial burden from "finances in general" was associated with treatment regret at 3 years (odds ratio [OR] = 2.47, 95% confidence interval [CI] = 1.33 to 4.57; P = .004); however, this association was no longer statistically significant at 5-year follow-up (OR = 1.19, 95% CI = 0.56 to 2.54; P = .7). CONCLUSIONS In this population-based sample of men with localized prostate cancer, we observed associations between financial burden and treatment regret. Our findings suggest indirect treatment costs, especially during the first 3 years after diagnosis, may impact patients more profoundly than direct costs and are important for inclusion in shared decision making.
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Affiliation(s)
- Daniel D Joyce
- Correspondence to: Daniel D. Joyce, MD, Department of Urology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA (e-mail: )
| | | | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ann S Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA
| | - Lisa E Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brock B O’Neil
- Department of Urology, University of Utah Health, Salt Lake City, UT, USA
| | - Sherrie H Kaplan
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Sheldon Greenfield
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA,Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Bauer AG, Jefferson M, Nahhas GJ, Savage S, Drake R, Lilly M, Ambrose L, Caulder S, Mahvi D, Hughes Halbert C. Financial toxicity and strain among men receiving prostate cancer care in an equal access healthcare system. Cancer Med 2020; 9:8765-8771. [PMID: 33070458 PMCID: PMC7724486 DOI: 10.1002/cam4.3484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To examine financial toxicity and strain among men in an equal access healthcare system based on social determinants and clinical characteristics. Methods Observational study among men receiving prostate cancer care (n = 49) at a Veterans Health Administration (VHA) facility. Financial hardship included overall financial strain and financial toxicity due to healthcare costs. Financial strain was measured with one item asking how much money they have leftover at the end of the month. Financial toxicity was measured with the Comprehensive Score for Financial Toxicity (COST) scale. Results Comprehensive Score for Financial Toxicity scores among participants indicated moderate levels of financial toxicity (M = 24.4, SD = 9.9). For financial strain, 36% of participants reported that they did not have enough money left over at the end of the month. There were no racial or clinically related differences in financial toxicity, but race and income level had significant associations with financial strain. Conclusion Financial toxicity and strain should be measured among patients in an equal access healthcare system. Findings suggest that social determinants may be important to assess, to identify patients who may be most likely to experience financial hardship in the context of obtaining cancer care and implement efforts to mitigate the burden for those patients.
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Affiliation(s)
- Alexandria G Bauer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Savage
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Urology, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - Richard Drake
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Michael Lilly
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Linda Ambrose
- Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - Susan Caulder
- Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - David Mahvi
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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