1
|
Johnstone T, Thawanyarat K, Rowley M, Francis S, Camacho JM, Singh D, Navarro Y, Shah JK, Nazerali RS. Racial Disparities in Postoperative Breast Reconstruction Outcomes: A National Analysis. J Racial Ethn Health Disparities 2024; 11:1199-1210. [PMID: 37074634 DOI: 10.1007/s40615-023-01599-1] [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: 01/20/2023] [Revised: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Studies have shown that Black patients are more likely to experience complications following breast reconstruction compared to other racial groups. Most of these studies have been conducted on patient populations focusing on either autologous or implant-based reconstruction without possible predictive indicators for complication disparities for all types of reconstruction procedures. The aim of this study is to elucidate disparities among patient demographics by identifying predictors of complications and postoperative outcomes among different racial/ethnic patients undergoing breast reconstruction utilizing multi-state, multi-institution, and national level data. METHODS Patients in the Optum Clinformatics Data Mart that underwent all billable forms of breast reconstruction were identified via CPT codes. Demographics, medical history, and postoperative outcome data were collected by querying relevant reports of CPT, ICD-9, and ICD-10 codes. Outcomes analysis was limited to the 90-day global postoperative period. A multivariable logistic-regression analysis was performed to ascertain the effects of age, patient reported ethnicity, coexisting conditions, and reconstruction type on the likelihood of any common postoperative complication occurring. Linearity of the continuous variables with respect to the logit of the dependent variable was confirmed. Odds ratios and corresponding 95% confidence intervals were calculated. RESULTS From over 86 million longitudinal patient records, our study population included 104,714 encounters for 57,468 patients who had undergone breast reconstruction between January 2003 and June 2019. Black race (relative to White), autologous reconstruction, hypertension, type II diabetes mellitus, and tobacco use were independent predictors of increased likelihood of complication. Specifically, the odds ratios for complication occurrence for Black, Hispanic, and Asian ethnicity (relative to White) were 1.09, 1.03, and 0.77, respectively. Black patients had an overall breast reconstruction complication rate of 20.4%, while the corresponding rate for White, Hispanic, and Asian patients were 17.0%, 17.9%, and 13.2%, respectively. CONCLUSION Our analysis of a national-level database shows that Black patients undergoing implant-based or autologous reconstruction have increased risk of complications, likely due to multifactorial components that play a role in the care of this patient population. While higher rates of comorbidities have been cited as a possible cause, providers must consider racial influences involving cultural context, historical mistrust in medicine, and physician/health institution factors that may drive this disparity of outcomes among our patients.
Collapse
Affiliation(s)
| | | | - Mallory Rowley
- State University of New York, Upstate Medical University, Syracuse, New York, NY, USA
| | | | | | - Dylan Singh
- University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Yelissa Navarro
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Jennifer K Shah
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Stanford, CA, 94304, USA
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Stanford, CA, 94304, USA.
| |
Collapse
|
2
|
Asogwa OA, Quansah DY, Boakye D, Ezewuiro ON, Boateng D. Prevalence, patterns, and determinants of multimorbidity among childhood and adult cancer survivors: A systematic review. Crit Rev Oncol Hematol 2023; 192:104147. [PMID: 37778707 DOI: 10.1016/j.critrevonc.2023.104147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023] Open
Abstract
Development of multimorbidity is common among cancer survivors due to their previous cancer, treatments, or changes in lifestyle. We summarized evidence on the prevalence, patterns, and determinants of multimorbidity among childhood and adult cancer survivors. We searched PubMed and EMBASE databases for articles reporting prevalence, patterns, and determinants of multimorbidity in cancer survivors. Finally, 23/500 articles were included. There was a large variation in the prevalence of multimorbidity (13-89%) among cancer survivors. Bone marrow transplantation, radiation, female sex, lower level of physical activity, increasing age, minority ethnicity, low-income, and low-education were associated with a higher prevalence of multimorbidity. Patterns of multimorbidity were both concordant and discordant. In conclusion, multimorbidity is highly prevalent and a major concern among cancer survivors. A personalized care plan that takes into account the identified risk may be beneficial to reduce the burden of multimorbidity and improve the quality of life among cancer survivors.
Collapse
Affiliation(s)
- Ogechukwu A Asogwa
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Dan Yedu Quansah
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne Switzerland Avenue de la Sallaz, CH-1011 Lausanne, Switzerland; Canadian Women Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel Boakye
- School of Health & Life Sciences, University of the West of Scotland, Glasgow PA1 2BE, UK
| | | | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
3
|
Busen K, Sanderson M, Banks AD, Wallace H, Nechuta S. Patterns of Physical Activity and the Role of Obesity and Comorbidities Among Long-term African American Breast Cancer Survivors. J Racial Ethn Health Disparities 2023; 10:2261-2272. [PMID: 36071314 PMCID: PMC10170401 DOI: 10.1007/s40615-022-01405-4] [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: 05/07/2022] [Revised: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Physical activity (PA) has many health benefits for cancer survivors, but little research has examined patterns and correlates in African American women, who have a higher burden of comorbidities and obesity. We examined PA types and patterns overall and by obesity and comorbidities among long-term (> 5 years) breast cancer survivors. METHODS This cross-sectional study included 323 women who were previous participants of a case-only study in three southeastern states. Women completed a survivorship-focused questionnaire using validated measures to collect data on cancer treatment, PA (recreational, household, transportation) and other lifestyle factors, and comorbidities. Logistic regression models estimated adjusted ORs and 95% CIs for total PA (all three types, categorized as tertiles) and meeting PA guidelines (> 150 min/week of exercise). RESULTS The mean age of women was 59.1 years (range 27.9-79.5). The most frequent PA types (≥ 1/month) included routine household cleaning (92.9%), shopping (94.7%), walking slowly (42.1%), and walking briskly (40.6%). Less than 40% met PA guidelines. Women with more total comorbidities, arthritis, and obesity had lower levels of total PA (minutes/week) and/or recreational PA. In adjusted models, BMI ≥ 35 kg/m2 was associated with reduced odds of total PA (OR = 0.33, 95% CI 0.12-0.88, highest tertile). Arthritis was associated with reduced odds of meeting PA guidelines (OR = 0.61, 95% CI 36-1.05). CONCLUSIONS Close to 60% of African American breast cancer survivors did not meet PA guidelines based on recreational PA participation. Household PA was an important source of PA. Comorbidities and obesity were associated with both reduced total PA and not meeting PA guidelines.
Collapse
Affiliation(s)
- Katherine Busen
- Department of Public Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA
| | - Maureen Sanderson
- School of Medicine, Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Allison D Banks
- School of Medicine, Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Heather Wallace
- Department of Public Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA
| | - Sarah Nechuta
- Department of Public Health, College of Health Professions, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA.
| |
Collapse
|
4
|
Connor AE, Dibble KE, Visvanathan K. Lifestyle factors in Black female breast cancer survivors—Descriptive results from an online pilot study. Front Public Health 2023; 11:1072741. [PMID: 36998282 PMCID: PMC10043444 DOI: 10.3389/fpubh.2023.1072741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundBreast cancer (BC) research examining disparities in cancer survivorship and modifiable risk behaviors has been mostly cancer-specific, leaving relevant gaps in disparities research relating to other cancer survivorship outcomes, including cardiovascular disease (CVD). Maintaining healthy lifestyle behaviors is a critical component of successful cancer survivorship, where unhealthy behaviors may increase the risk for recurrence, second primary cancers, and incidence of new comorbid conditions, including CVD. The current study describes BC survivorship factors among an online pilot study of Black BC survivors in Maryland, with a focus on the burden of obesity, comorbidity, and behavioral factors associated with CVD risk.MethodsUtilizing social media recruitment strategies and survivor networks, we recruited 100 Black female BC survivors to complete an online survey. Descriptive characteristics (demographic, clinical, and lifestyle factors) were analyzed in terms of frequencies, means, standard deviations (SD) overall and by county.ResultsThe average ages at time of survey and at primary BC diagnosis were 58.6 years (SD = 10.1) and 49.1 years (SD = 10.2), respectively. More than half of the survivors reported having hypertension (51%); and while only 7% reported being obese at the time of BC diagnosis, 54% reported being obese at the time of survey which was on average 9 years post BC diagnosis. Only 28% of the survivors reported meeting weekly exercise recommendations. While 70% were never smokers, most ever smokers resided in Baltimore City/Baltimore County (n = 18 ever smokers).ConclusionOur pilot study identified at-risk BC survivors in Maryland due to the high prevalence of CVD risk factors (hypertension, obesity, limited exercise). These pilot study methods will inform a future statewide multilevel prospective study to improve health behaviors among Black BC survivors.
Collapse
Affiliation(s)
- Avonne E. Connor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
- *Correspondence: Avonne E. Connor
| | | | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| |
Collapse
|
5
|
Ashing KT, Song G, Jones V, Brenner C, Samoa R. Racial disparities in diabetes prevalence among cancer patients. Front Oncol 2023; 12:1099566. [PMID: 36713552 PMCID: PMC9880440 DOI: 10.3389/fonc.2022.1099566] [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: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Cancer inequity is one of the most critical public health issues faced by ethnic minorities and people of lower socioeconomic status. The disparate burden of cancer is caused by poor access to care and inadequate delivery of cancer treatment, as well as comorbid and co-occurring conditions. Diabetes is a common and serious comorbid condition of cancer. Methods To better understand diabetes prevalence among diverse cancer patients, this study analyzed and described characteristics of cancer patients with diabetes from local-level Service Planning Area (SPA) data using City of Hope Comprehensive Cancer Center data, and United States national-level data from The National Health Interview Survey. Results Findings from national level data showed that patients in racial/ethnic minority groups had a higher occurrence of being diagnosed with diabetes, especially for non-Hispanic Blacks (OR=1.76, 95% CI=1.51, 2.03) and Hispanic/Latino individuals (OR=1.34, 95% CI=1.18, 1.52). Cancer patients who are older, ethnic minority, overweight/obese and with lower educational levels were more likely to have co-occurring diabetes. SPA-level patient data found similar results. Discussion In response to our findings and other reports, clinicians and health system including health coverage organizations should routinely assess cancer patients for cooccurring chronic illnesses, in particular diabetes. Interventions improving coordinated care that integrates oncology, endocrinology and primary care, targeting cancer patients --especially racial/ethnic minorities, overweight/obese, and older patients who are at increased risk for diabetes -- ought to be considered as best practice Whole Person care. With coordinated care management, ethnic disparities in cancer may be better addressed and reduced. Additionally, policymakers can contribute by enacting policies improving access to and coverage of integrated oncology, chronic disease prevention, and associated specialty care i.e., endocrinology to equalize quality care for ethnic minority, lower educated, overweight/obese and older cancer patients who are more likely to suffer greater comorbidity, and inadequate oncology and coordinated care to reduce disparities.
Collapse
Affiliation(s)
- Kimlin Tam Ashing
- Department of Population Sciences, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, United States,*Correspondence: Kimlin Tam Ashing,
| | - Gaole Song
- Department of Population Sciences, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, United States
| | - Veronica Jones
- Department of Population Sciences, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, United States,Department of Surgery, City of Hope National Medical Center, California, CA, United States
| | - Charles Brenner
- Department of Diabetes & Cancer Metabolism, City of Hope National Medical Center, California, CA, United States
| | - Raynald Samoa
- Department of Diabetes, Endocrinology & Metabolism, City of Hope National Medical Center, California, CA, United States
| |
Collapse
|
6
|
Connor AE, Kaur M, Sheng JY, Hayes JH. Racial disparities in mortality outcomes among women diagnosed with breast cancer in Maryland: Impact of cardiovascular disease and clinical characteristics. Cancer 2022; 128:727-736. [PMID: 34873682 DOI: 10.1002/cncr.33889] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although racial disparities in breast cancer (BC) mortality have been well documented in the United States, little is known about the impact of coexisting cardiovascular disease (CVD) and other clinical factors on Black-White survival disparities after the diagnosis of BC. This study examined the associations of race, CVD, and clinical factors at diagnosis with the hazard of BC and CVD-related mortality among patients with BC identified from the Maryland Cancer Registry. METHODS A total of 36,088 women (25,181 Whites and 10,907 Blacks) diagnosed with incident invasive BC between 2007 and 2017 were included. Subdistribution hazard ratios (sdHRs) for CVD-related and BC mortality were estimated with Fine and Gray regression models, which accounted for the influence of competing events. RESULTS After a median follow-up of 5.8 years, 8019 deaths occurred; 3896 were BC deaths, and 1167 deaths were CVD-related. Black women had a higher hazard of BC mortality (sdHR, 1.66; 95% confidence interval [CI], 1.55-1.77) and CVD mortality (sdHR, 1.33; 95% CI, 1.17-1.51) in comparison with White women. Associations with CVD mortality were significantly stronger among Black women aged 50 to 59 years (sdHR, 2.86; 95% CI, 1.84-4.44; P for interaction < .001). Among Black women with CVD, the hazard of BC death was 41% higher in comparison with White women. By treatment, a significant association with CVD mortality was observed only among Black women undergoing surgery and radiation (sdHR, 1.61; 95% CI, 1.22-2.13). CONCLUSIONS Clinicians should consider the impact of younger age, preexisting CVD, and BC treatments among Black patients. Early identification of those at risk for worse survival may improve surveillance and outcomes.
Collapse
Affiliation(s)
- Avonne E Connor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Maneet Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Y Sheng
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Jennifer H Hayes
- Maryland Cancer Registry, Prevention and Health Promotion Administration, Maryland Department of Health, Baltimore, Maryland
| |
Collapse
|
7
|
Connor AE, Kaur M, Dibble KE, Visvanathan K, Dean LT, Hayes JH. Racialized Economic Segregation and Breast Cancer Mortality among Women in Maryland. Cancer Epidemiol Biomarkers Prev 2022; 31:413-421. [PMID: 34862211 PMCID: PMC8825681 DOI: 10.1158/1055-9965.epi-21-0923] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Our objective was to determine the association between racialized economic segregation and the hazard of breast cancer mortality in Maryland. METHODS Among 35,066 women (24,540 White; 10,526 Black) diagnosed with incident invasive breast cancer in Maryland during 2007 to 2017, exposure to racialized economic segregation was measured at the census tract level using Index of Concentration at the Extremes metrics. HRs and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression for the association between racialized economic segregation and the hazard of breast cancer mortality, accounting for clustering at the census tract level. Models were adjusted for age and stratified by race, median age (<60 years, ≥60 years), and clinical characteristics. RESULTS Overall, the hazard of breast cancer mortality was 1.84 times as high (95% CI, 1.64-2.06) for the least privileged quintile of racialized economic segregation compared with the most privileged quintile. This association differed significantly (P interaction< 0.05) by race and age, with 1.20 (95% CI, 0.90-1.60) times the hazard of breast cancer mortality for Black women versus 1.66 (95% CI, 1.41-1.95) times the hazard for White women, and with greater hazards for younger women (HR, 2.17; 95% CI, 1.83-2.57) than older women (HR, 1.62; 95% CI, 1.40-1.88). CONCLUSIONS Our results suggest that breast cancer survival disparities exist in Maryland among women residing in the least privileged census tracts with lower income households and higher proportions of Black residents. IMPACT Our findings provide new insights into the breast cancer mortality disparities observed among women in Maryland.
Collapse
Affiliation(s)
- Avonne E Connor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Maneet Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kate E Dibble
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Lorraine T Dean
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Jennifer H Hayes
- Maryland Cancer Registry and Prevention & Health Promotion Administration, Maryland Department of Health, Baltimore, Maryland
| |
Collapse
|
8
|
Undercutting efforts of precision medicine: roadblocks to minority representation in breast cancer clinical trials. Breast Cancer Res Treat 2021; 187:605-611. [PMID: 34080093 DOI: 10.1007/s10549-021-06264-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022]
Abstract
Precision (or personalized) medicine holds great promise in the treatment of breast cancer. The success of personalized medicine is contingent upon inclusivity and representation for minority groups in clinical trials. In this article, we focus on the roadblocks for the African American demographic, including the barriers to access and enrollment in breast oncology trials, the prevailing classification of race and ethnicity, and the need to refine monolithic categorization by employing genetic ancestry mapping tools for a more accurate determination of race or ethnicity.
Collapse
|
9
|
Park J, Rodriguez JL, O'Brien KM, Nichols HB, Hodgson ME, Weinberg CR, Sandler DP. Health-related quality of life outcomes among breast cancer survivors. Cancer 2020; 127:1114-1125. [PMID: 33237602 DOI: 10.1002/cncr.33348] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Data from a nationwide sample of US breast cancer survivors were used to examine associations between patient characteristics (breast cancer clinical features, prognostic factors, and treatments) and health-related quality of life (HRQOL). Associations between postdiagnosis HRQOL and mortality were then evaluated. METHODS The authors identified female breast cancer survivors (n = 2453) from the Sister Study or Two Sister Study who were at least 1 year from breast cancer diagnosis and who had responded to a survivorship survey in 2012. HRQOL was assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) Global 10 measures. Multivariable linear regression was used to assess predictors associated with HRQOL. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between HRQOL and all-cause mortality. RESULTS HRQOL, assessed an average of 4.9 years after the cancer diagnosis (standard deviation of 1.9 years), was negatively associated with a higher cancer stage at diagnosis; a higher comorbidity score at the survey; experience of surgical complications; dissatisfaction with breast surgery; and experience of any recent recurrence, metastasis, or secondary malignancy. Since the completion of the survey, there were 85 deaths (3.5%) during a mean follow-up of 4 years (standard deviation of 0.5 years). In multivariate models, decreases in PROMIS physical T scores and mental T scores were associated with increased mortality (HR for physical T scores, 1.08; 95% CI, 1.05-1.11; HR for mental T scores, 1.03; 95% CI, 1.01-1.06). CONCLUSIONS Prognostic and cancer treatment-related factors affect HRQOL in breast cancer survivors and may inform targeted survivorship care. PROMIS global health measures may offer additional insights into patients' well-being and mortality risk. LAY SUMMARY Findings from a study suggest that prognostic and cancer treatment-related factors affect health-related quality of life (HRQOL) in breast cancer survivors and that poor HRQOL may increase the mortality risk. The evaluation of HRQOL is important because it may hold potential as a tool for optimizing survivorship care.
Collapse
Affiliation(s)
- Jihye Park
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Juan L Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| |
Collapse
|
10
|
Chebli P, Lemus J, Avila C, Peña K, Mariscal B, Merlos S, Guitelman J, Molina Y. Multilevel determinants of financial toxicity in breast cancer care: perspectives of healthcare professionals and Latina survivors. Support Care Cancer 2020; 28:3179-3188. [PMID: 31712953 PMCID: PMC7214214 DOI: 10.1007/s00520-019-05119-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Financial toxicity is a multidimensional side effect of cancer treatment. Yet, most relevant research has focused on individual-level determinants of financial toxicity and characterized only patient perspectives. This study examined the multilevel determinants of financial toxicity from the perspectives of Latina breast cancer survivors and healthcare professionals. METHODS We analyzed qualitative data from focus groups with 19 Latina breast cancer survivors and interviews with 10 healthcare professionals recruited through community partners and venues in Chicago. RESULTS At the individual-level, the lack of knowledge and prioritization regarding financial aspects of care (e.g., costs of treatment, insurance coverage) was identified as important determinants of financial toxicity. However, healthcare professionals emphasized the need for early financial planning, while survivors prioritized survival over financial concerns immediately after diagnosis. At the interpersonal-level, social networks were identified as important platforms for disseminating information on financial resources. At the community-level, community norms and dynamics were identified as important barriers to seeking financial assistance. Access to culturally astute community-based organizations was considered one potential solution to eliminate these barriers. At the organizational/healthcare policy-level, financial assistance programs' restrictive eligibility criteria, lack of coverage post-treatment, limited availability, and instability were identified as major determinants of financial toxicity. CONCLUSION Our findings suggest that multilevel interventions at the individual-, interpersonal-, community-, and organizational/healthcare policy-levels are needed to adequately address financial toxicity among Latina and other survivors from disadvantaged communities.
Collapse
Affiliation(s)
- Perla Chebli
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA
| | - Jocelyne Lemus
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA
| | - Corazón Avila
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA
| | - Kryztal Peña
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA
| | | | | | | | - Yamilé Molina
- School of Public Health, University of Illinois at Chicago, 649 SPHPI MC923, Chicago, IL, USA.
| |
Collapse
|
11
|
Lee KT, George M, Lowry S, Ashing KT. A Review and Considerations on Palliative Care Improvements for African Americans With Cancer. Am J Hosp Palliat Care 2020; 38:671-677. [PMID: 32489113 DOI: 10.1177/1049909120930205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hospice and Palliative care benefits are infrequently realized by African American patients with cancer. With the increasing recognition of the critical role of early utilization of palliative services for optimal and quality patient care, it is important to acknowledge disparities and barriers to access that minority patients may face. The purpose of this paper is to discuss the status of palliative care delivery for African American patients within the structure and framework of the clinical practice guideline domains established by the National Consensus Project for Palliative Care. This perspectives paper describes the different aspects of palliative care and the interplay with African American culture. Here, we also attempt to identify the multilevel barriers (health care system and provider level) to palliative care among African Americans as a required step toward decreasing the disparities in access, coverage, utilization, and benefit of palliative care. Furthermore, this paper may serve as an educational guide for health care workers who care for African American patients with cancer.
Collapse
Affiliation(s)
- Kimberley T Lee
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Marshalee George
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Sarah Lowry
- Department of Hematology/Medical Oncology, 89020School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kimlin T Ashing
- Division of Health Equities, 20220City of Hope Medical Center, Duarte, CA, USA
| |
Collapse
|
12
|
Samayoa C, Santoyo-Olsson J, Escalera C, Stewart AL, Ortiz C, Márquez-Magaña L, Urias A, Gonzalez N, Cervantes SA, Torres-Nguyen A, Parada-Ampudia L, Nápoles AM. Participant-Centered Strategies for Overcoming Barriers to Biospecimen Collection among Spanish-Speaking Latina Breast Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2020; 29:606-615. [PMID: 32132128 PMCID: PMC7062229 DOI: 10.1158/1055-9965.epi-19-0942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/12/2019] [Accepted: 01/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Latinos are underrepresented in biomedical research, particularly biomarker research, yet they constitute the nation's largest ethnic/racial minority. Optimal methods for obtaining biospecimens for biomarker research among Latinos need to be identified. To minimize barriers and enhance participation, this study developed and tested tailored strategies for collecting biomarkers of chronic stress and premature aging among Spanish-speaking Latina breast cancer survivors. METHODS This study used a community-based participatory approach and selected hair and saliva as noninvasive biospecimens to assess telomere length, the cortisol awakening response (CAR), and hair cortisol concentration. We developed bilingual multimedia instructional materials, and community health workers assisted in collections. Telephone surveys assessed willingness to participate in future studies, barriers to sample collection, and recommendations for improving the strategies. RESULTS A total of 103 participants were recruited over 18 months from two rural sites in California, and 88 were retained at 6-month follow-up. At baseline, rates of donating salivary DNA for telomere length measurement, saliva for CAR analysis, and hair for cortisol concentration were 98%, 89%, and 52%, respectively. At follow-up, rates were 83%, 76%, and 55%, respectively. The majority of participants reported being very willing to provide hair (72%) or saliva (74%) for future studies. CONCLUSIONS Our results support the feasibility of including minorities in biomedical research. We report excellent rates of saliva collection when community partners are engaged in the process, and when patient-centered and culturally tailored recruitment methods are implemented. IMPACT The development of methods to facilitate the inclusion of minorities in biomedical research is critical to eliminate racial/ethnic health disparities.
Collapse
Affiliation(s)
- Cathy Samayoa
- Health Equity Research Lab, Department of Biology, San Francisco State University, San Francisco, California.
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Cristian Escalera
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, San Francisco, California
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, California
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, San Francisco, California
| | - Leticia Márquez-Magaña
- Health Equity Research Lab, Department of Biology, San Francisco State University, San Francisco, California
| | - Aday Urias
- Cancer Resource Center of the Desert, El Centro, California
| | | | - Silvia A Cervantes
- Community Outreach Department, Kaweah Delta Health District, Visalia, California
| | - Alma Torres-Nguyen
- Community Outreach Department, Kaweah Delta Health District, Visalia, California
| | - Lorenia Parada-Ampudia
- WomenCARE/Entre Nosotras, Family Service Agency of the Central Coast, Soquel, California
| | - Anna M Nápoles
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
13
|
A Single-Center Retrospective Chart Review to Determine Whether the Presence of Comorbidities Affects Colon Cancer Screenings in African Americans. Gastroenterol Nurs 2020; 43:40-52. [PMID: 31990872 DOI: 10.1097/sga.0000000000000402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Colon cancer is the third leading cause of cancer-related death in African Americans. Although the rates of colon screenings have risen, African Americans remain to be underscreened, and are more likely to present with advanced lesions. This population has a higher prevalence of inflammatory comorbidities, and their effects on screenings have not been fully explored. Along with higher rates of comorbidities, the Southeastern United States is one region for the highest rates of colorectal cancer. The purpose of this study was to determine whether people with comorbidities were more likely to have a screening colonoscopy. Convenience sampling was used to procure 408 patients. The median age was 55 years, and the majority were females (52.2%), who were obese (29.2%), and nonsmokers (52.2%). The most common comorbidity was hypertension (70.3%), followed by osteoarthritis (39%), and diabetes (25.5%). There is a well-documented trend between certain inflammatory comorbidities and higher death rates in patients with colorectal cancer. Clarifying the relationship between comorbidities and cancer starts with screening as many patients as possible. Therefore, interventions that support increasing the number of colorectal cancer screenings are imperative in order to improve morbidity and mortality in this despaired population.
Collapse
|
14
|
Xing CY, Doose M, Qin B, Lin Y, Plascak JJ, Omene C, He C, Demissie K, Hong CC, Bandera EV, Llanos AAM. Prediagnostic Allostatic Load as a Predictor of Poorly Differentiated and Larger Sized Breast Cancers among Black Women in the Women's Circle of Health Follow-Up Study. Cancer Epidemiol Biomarkers Prev 2019; 29:216-224. [PMID: 31719063 DOI: 10.1158/1055-9965.epi-19-0712] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/16/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Few studies have empirically tested the association of allostatic load (AL) with breast cancer clinicopathology. The aim of this study was to examine the association of AL, measured using relevant biomarkers recorded in medical records before breast cancer diagnosis, with unfavorable tumor clinicopathologic features among Black women. METHODS In a sample of 409 Black women with nonmetastatic breast cancer who are enrolled in the Women's Circle of Health Follow-Up Study, we estimated prediagnostic AL using two measures: AL measure 1 [lipid profile-based-assessed by systolic and diastolic blood pressure (SBP, DBP), high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides, and glucose levels; waist circumference; and use of diabetes, hypertension, or hypercholesterolemia medication] and AL measure 2 (inflammatory index-based-assessed by SBP, DBP, glucose, and albumin levels; estimated glomerular filtration rate; body mass index; waist circumference; and use of medications previously described). We used Cohen's statistic to assess agreement between the two AL measures and multivariable logistic models to assess the associations of interest. RESULTS AL measures 1 and 2 moderately agreed (κ = 0.504). Higher prediagnostic AL predicted higher grade (poorly differentiated vs. well/moderately differentiated) using AL measure 1 [OR = 2.16; 95% confidence interval (CI), 1.18-3.94] and AL measure 2 (OR = 1.60; 95% CI, 1.02-2.51), and larger tumor size (≥2 cm vs. <2 cm; OR = 1.58; 95% CI, 1.01-2.46) using AL measure 2 only. CONCLUSIONS Elevated prediagnostic AL might contribute to more unfavorable breast cancer clinicopathology. IMPACT Addressing elevated prediagnostic levels of AL has potentially important clinical implications.
Collapse
Affiliation(s)
- Cathleen Y Xing
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Michelle Doose
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Bo Qin
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Yong Lin
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jesse J Plascak
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Coral Omene
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Chunyan He
- Division of Medical Oncology, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky.,Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University School of Public Health, Brooklyn, New York
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elisa V Bandera
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Adana A M Llanos
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey. .,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| |
Collapse
|
15
|
Park SH, Strauss SM. Similarities and differences in the correlates of comorbidities in US male and female adult cancer survivors. Public Health Nurs 2019; 36:478-487. [PMID: 31058360 DOI: 10.1111/phn.12617] [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: 02/12/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine both the common and the sex-specific correlates of comorbidities in adult male and female cancer survivors. DESIGN Cross-sectional study using the 2009-2014 National Health and Nutrition Examination Survey (NHANES). SAMPLE Male (n = 667) and female (n = 772) cancer survivors 20 years of age and older. MEASUREMENTS Questionnaire responses from NHANES provided data for this study. Comorbidities were assessed using a modified Charlson Comorbidity Index (CCI). Bivariate and multivariate linear regression analyses were conducted to identify correlates of comorbidities in male and female cancer survivors separately. RESULTS The mean modified CCI score was 3.88 in males and 3.68 in females. Having a greater number of cancers diagnosed, being currently or formerly married, being physically inactive, having lower socioeconomic status, and being a former smoker were significant correlates of comorbidities in both males and females. Having a prostate cancer diagnosis was also a significant correlate of comorbidities in males. White race, more years since first cancer diagnosis, being overweight or obese, and having no more than a high school education were also significant correlates of comorbidities in females. CONCLUSIONS There are differences between correlates of comorbidities in male and female cancer survivors.
Collapse
Affiliation(s)
- So-Hyun Park
- Hunter Bellevue School of Nursing, City University of New York, New York, New York
| | - Shiela M Strauss
- Hunter Bellevue School of Nursing, City University of New York, New York, New York.,New York University Rory Meyers College of Nursing, New York, New York
| |
Collapse
|
16
|
Teysir J, Gegechkori N, Wisnivesky JP, Lin JJ. Racial disparities in surveillance mammography among older breast cancer survivors. Breast Cancer Res Treat 2019; 176:461-467. [DOI: 10.1007/s10549-019-05250-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/20/2019] [Indexed: 12/16/2022]
|
17
|
Yuan Y, Taneja M, Connor AE. The Effects of Social and Behavioral Determinants of Health on the Relationship Between Race and Health Status in U.S. Breast Cancer Survivors. J Womens Health (Larchmt) 2018; 28:1632-1639. [PMID: 30565965 DOI: 10.1089/jwh.2018.7360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: To examine the association between race and health outcomes among U.S. breast cancer (BC) survivors and explore to what extent do social and behavioral factors contribute to racial disparities for these associations. Materials and Methods: Four hundred forty-one female participants diagnosed with BC in the National Health and Nutrition Examination Survey from 2007 to 2016 were included in this study. Poisson regression with robust variance was used to estimate the prevalence ratio (PrR) and 95% confidence intervals for the associations between race, diabetes, hypertension, and other cancers. Results: The PrR for co-occurrence of diabetes and hypertension was 2.21 (p < 0.001) and 1.62 (p < 0.001) times, respectively, among African Americans (AA) compared with non-Hispanic whites. Body mass index (BMI) explained 17.5% of the association between AA race and diabetes prevalence; a smaller reduction (7.8%) was observed adjusting for type of health insurance coverage, only. A 23.5% reduction was observed in the association between AA race and diabetes prevalence with adjustment for BMI and insurance. The association between AA race and hypertension prevalence was reduced by <6% with addition of individual risk factors, including education, insurance, poverty, obesity, smoking, and physical activity, and with adjustment of the combination of these factors. Conclusions: The association between AA race and diabetes prevalence among BC survivors may be partially explained by BMI and insurance coverage to a lesser extent. Interventions to improve outcomes among AA survivors should focus on weight management strategies.
Collapse
Affiliation(s)
- Yao Yuan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monica Taneja
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| |
Collapse
|
18
|
Husain M, Nolan TS, Foy K, Reinbolt R, Grenade C, Lustberg M. An overview of the unique challenges facing African-American breast cancer survivors. Support Care Cancer 2018; 27:729-743. [PMID: 30460398 DOI: 10.1007/s00520-018-4545-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/07/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The existence of cancer disparities is well known. Focus on alleviating such disparities centers on diagnosis, treatment, and mortality. This review surveyed current knowledge of health disparities that exist in the acute survivorship period (immediately following diagnosis and treatment) and their contributors, particularly for African-American breast cancer survivors (AA-BCS). METHODS Utilizing the ASCO four components of survivorship care, we explore disparities in surveillance and effects of cancer and therapies that AA-BCS face within the acute survivorship period (the years immediately following diagnosis). A literature review of PUBMED, Scopus, and Cochrane databases was conducted to identify articles related to AA-BCS acute survivorship. The search yielded 97 articles. Of the 97 articles, 38 articles met inclusion criteria. RESULTS AA-BCS experience disparate survivorship care, which negatively impacts quality of life and health outcomes. Challenges exist in surveillance, interventions for late effects (e.g., quality-of-life outcomes, cardiotoxicity, and cognitive changes), preventing recurrence with promotion of healthy living, and coordinating care among the healthcare team. CONCLUSIONS This overview identified current knowledge on the challenges in survivorship among AA-BCS. Barriers to optimal survivorship care inhibit progress in eliminating breast cancer disparities. Research addressing best practices for survivorship care is needed for this population. Implementation of culturally tailored care may reduce breast cancer disparities among AA-BCS.
Collapse
Affiliation(s)
- Marium Husain
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA.
| | - Timiya S Nolan
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Kevin Foy
- The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Raquel Reinbolt
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Cassandra Grenade
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| | - Maryam Lustberg
- Medical Oncology, The Ohio State University, 320 W. 10th Ave, Suite A455, Columbus, OH, 43210, USA
| |
Collapse
|
19
|
Sleight AG, Lyons KD, Vigen C, Macdonald H, Clark F. The association of health-related quality of life with unmet supportive care needs and sociodemographic factors in low-income Latina breast cancer survivors: a single-centre pilot study. Disabil Rehabil 2018; 41:3151-3156. [PMID: 30052478 DOI: 10.1080/09638288.2018.1485179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Purpose: Determine correlations between health-related quality of life (HRQOL), supportive care need, and sociodemographic factors in low-income Latina breast cancer survivors.Methods: A descriptive, survey-based, cross-sectional study was completed with 102 low-income Latina breast cancer survivors at a major public safety net hospital. Correlation coefficients were calculated between number of unmet supportive care needs (per Supportive Care Needs Survey), HRQOL (per SF-36), and sociodemographic variables.Results: Unmet supportive care needs were correlated with lower HRQOL in all domains (r > -0.40; p < 0.0001). Lower income was significantly associated with lower HRQOL (r > 0.21; p < 0.05) and more supportive care needs (r = -0.22; p < 0.05). Multimorbidity was significantly associated with decreased HRQOL (r > -0.23; p < 0.05) and greater supportive care need (r = 0.19; p < 0.05).Conclusions: Identifying and addressing unmet supportive care needs may improve HRQOL in low-income Latina breast cancer survivors. Rehabilitation interventions that address barriers to accessing supportive care related to low SES and multimorbidity may also improve health outcomes in this population. The dual effect of multimorbidity on both quality of life and level of supportive care need in this population warrants further investigation.Implications for rehabilitationScreening for unmet supportive care needs may be an important step in improving health-related quality of life during cancer rehabilitation.Challenges accompanying multimorbidity and lower socioeconomic status may prevent low-income cancer patients from accessing adequate supportive care.Rehabilitation interventions for socioeconomically disadvantaged cancer survivors should compensate for both socioeconomic status and the presence of comorbidities in order to reduce disparities in quality of life during survivorship.
Collapse
Affiliation(s)
- Alix G Sleight
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kathleen Doyle Lyons
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Cheryl Vigen
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Heather Macdonald
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Florence Clark
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
20
|
Impact of Comorbidity on Symptoms and Quality of Life Among Patients Being Treated for Breast Cancer. Cancer Nurs 2018; 42:381-387. [DOI: 10.1097/ncc.0000000000000623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Williams VL, Awasthi S, Fink AK, Pow‐Sang JM, Park JY, Gerke T, Yamoah K. African-American men and prostate cancer-specific mortality: a competing risk analysis of a large institutional cohort, 1989-2015. Cancer Med 2018; 7:2160-2171. [PMID: 29601662 PMCID: PMC5943433 DOI: 10.1002/cam4.1451] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 11/12/2022] Open
Abstract
Significant racial disparities in prostate cancer (PCa) outcomes have been reported, with African-American men (AAM) more likely to endure adverse oncologic outcomes. Despite efforts to dissipate racial disparities in PCa, a survival gap persists and it remains unclear to what extent this disparity can be explained by known clinicodemographic factors. In this study, we leveraged our large institutional database, spanning over 25 years, to investigate whether AAM continued to experience poor PCa outcomes and factors that may contribute to racial disparities in PCa. A total of 7307 patients diagnosed with PCa from 1989 through 2015 were included. Associations of race and clinicodemographic characteristics were analyzed using chi-square for categorical and Mann-Whitney U-test for continuous variables. Racial differences in prostate cancer outcomes were analyzed using competing risk analysis methods of Fine and Gray. Median follow-up time was 106 months. There were 2304 deaths recorded, of which 432 resulted from PCa. AAM were more likely to be diagnosed at an earlier age (median 60 vs. 65 years, P = <0.001) and were more likely to have ≥1 comorbidities (13.6% vs. 7.5%, P < 0.001). In a multivariate competing risk model, adjusted for baseline covariates, AAM experienced significantly higher risk of PCSM compared to NHW men (HR, 1.62, 95% CI, 1.02-2.57, P = 0.03) NHW. Among men diagnosed at an older age (>60 years), racial differences in PCSM were more pronounced, with AAM experiencing higher rates of PCSM (HR, 2.05, 95% CI, 1.26-3.34, P = 0.003). After adjustment of clinicodemographic and potential risk factors, AAM continue to experience an increased risk of mortality from PCa, especially older AAM. Furthermore, AAM are more likely to be diagnosed at an early age and more likely to have higher comorbidity indices.
Collapse
Affiliation(s)
| | - Shivanshu Awasthi
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Angelina K. Fink
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Julio M. Pow‐Sang
- Department of Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Jong Y. Park
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Travis Gerke
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Kosj Yamoah
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
- Department of Radiation OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| |
Collapse
|
22
|
Sugita B, Gill M, Mahajan A, Duttargi A, Kirolikar S, Almeida R, Regis K, Oluwasanmi OL, Marchi F, Marian C, Makambi K, Kallakury B, Sheahan L, Cavalli IJ, Ribeiro EM, Madhavan S, Boca S, Gusev Y, Cavalli LR. Differentially expressed miRNAs in triple negative breast cancer between African-American and non-Hispanic white women. Oncotarget 2018; 7:79274-79291. [PMID: 27813494 PMCID: PMC5346713 DOI: 10.18632/oncotarget.13024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/25/2016] [Indexed: 01/09/2023] Open
Abstract
Triple Negative Breast Cancer (TNBC), a clinically aggressive subtype of breast cancer, disproportionately affects African American (AA) women when compared to non-Hispanic Whites (NHW). MiRNAs(miRNAs) play a critical role in these tumors, through the regulation of cancer driver genes. In this study, our goal was to characterize and compare the patterns of miRNA expression in TNBC of AA (n = 27) and NHW women (n = 30). A total of 256 miRNAs were differentially expressed between these groups, and distinct from the ones observed in their respective non-TNBC subtypes. Fifty-five of these miRNAs were mapped in cytobands carrying copy number alterations (CNAs); 26 of them presented expression levels concordant with the observed CNAs. Receiving operating characteristic (ROC) analysis showed a good power (AUC ≥ 0.80; 95% CI) for over 65% of the individual miRNAs and a high combined power with superior sensitivity and specificity (AUC = 0.88 (0.78−0.99); 95% CI) of the 26 miRNA panel in discriminating TNBC between these populations. Subsequent miRNA target analysis revealed their involvement in the interconnected PI3K/AKT, MAPK and insulin signaling pathways. Additionally, three miRNAs of this panel were associated with early age at diagnosis. Altogether, these findings indicated that there are different patterns of miRNA expression between TNBC of AA and NHW women and that their mapping in genomic regions with high levels of CNAs is not merely physical, but biologically relevant to the TNBC phenotype. Once validated in distinct cohorts of AA women, this panel can potentially represent their intrinsic TNBC genome signature.
Collapse
Affiliation(s)
- Bruna Sugita
- Department of Genetics, Federal University of Paraná, Curitiba, PR, Brazil
| | - Mandeep Gill
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Akanskha Mahajan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Anju Duttargi
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Saurabh Kirolikar
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Rodrigo Almeida
- Department of Genetics, Federal University of Paraná, Curitiba, PR, Brazil
| | - Kenny Regis
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Olusayo L Oluwasanmi
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Fabio Marchi
- International Research Center-CIPE, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Catalin Marian
- The Ohio State University Comprehensive Cancer Center, Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, Ohio.,The University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Kepher Makambi
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Departments of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC USA
| | - Bhaskar Kallakury
- Department of Pathology, Georgetown University Medical Center, Washington, DC, USA
| | - Laura Sheahan
- Innovation Center for Biomedical Informatics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Iglenir J Cavalli
- Department of Genetics, Federal University of Paraná, Curitiba, PR, Brazil
| | - Enilze M Ribeiro
- Department of Genetics, Federal University of Paraná, Curitiba, PR, Brazil
| | - Subha Madhavan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Innovation Center for Biomedical Informatics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Simina Boca
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Innovation Center for Biomedical Informatics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Yuriy Gusev
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Innovation Center for Biomedical Informatics, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Luciane R Cavalli
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| |
Collapse
|
23
|
Lim JW. The impact of comorbidity on the relationship between life stress and health-related quality of life for Chinese- and Korean-American breast cancer survivors. ETHNICITY & HEALTH 2018; 23:16-32. [PMID: 27764966 PMCID: PMC6201289 DOI: 10.1080/13557858.2016.1246428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The current study aimed to (1) identify the occurrence of comorbidities among Chinese- and Korean-American breast cancer survivors (BCS), (2) examine whether health-related quality of life (HRQOL) scores varied with the occurrence of specific comorbidities, and (3) investigate the mediating effect of comorbidities on the relationship between life stress and HRQOL. DESIGN Data were drawn from the parent study, a cross-sectional study investigating HRQOL in 86 Chinese- and 71 Korean-American BCS in Southern California. Two comorbidity-related variables, the occurrence of the specific comorbidity and the total number of comorbidities, were used to comprehensively reflect the characteristics of comorbidity. RESULTS Approximately 60% of participants had at least one comorbid disease, and osteoporosis was the most prevalent comorbidity. HRQOL differences based on the occurrence of a specific comorbidity were evident for arthritis, eye/vision problems, dental and gum problems, lymphedema, and psychological difficulties. Structural equation modeling demonstrated that the nature of the outcome variable, either physical or mental HRQOL, influenced the overall patterns of the findings. For example, life stress was significantly associated with the total number of comorbidities and in turn influenced physical HRQOL. In terms of mental HRQOL, arthritis, dental and gum problems, chronic pain, heart disease, lymphedema, and psychological difficulties mediated the relationship between life stress and mental HRQOL. CONCLUSION The current study adds to the existing literature by examining the mediating effects of comorbidity on the relationship between life stress and HRQOL. The findings support the need for health care professionals to clearly assess physical and psychological comorbidities when providing survivorship care for cancer survivors.
Collapse
Affiliation(s)
- Jung-Won Lim
- a College of Social Welfare , Kangnam University , Yongin , Korea
| |
Collapse
|
24
|
Christian AH, O'Malley D, Barac A, Miller SM, Hudson SV. Cardiovascular risk and communication among early stage breast cancer survivors. PATIENT EDUCATION AND COUNSELING 2017; 100:1360-1366. [PMID: 28215826 PMCID: PMC5568653 DOI: 10.1016/j.pec.2017.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE African American (AA) women have disproportionately high rates of cardiovascular (CV) risk factors that, coupled with potentially cardiotoxic breast cancer (BC) therapies, place them at risk of adverse CV outcomes. The purpose of this study was to assess CV risk factors among white and AA BC survivors and perceptions of patient-provider CV-related communication and post-treatment information needs. METHODS Early-stage, English-speaking BC survivors were recruited through community-based survivorship organizations/clinics in New Jersey. Qualitative, semi-structured interviews and a brief survey of socio-demographics and comorbidities were conducted. RESULTS BC survivors reported high rates of CV risk factors. Most reported their health as good/excellent despite their cancer history and CV risk profile. Approximately half of overweight/obese BC survivors reported no weight-related conversation with their health care team and, among those who reported discussion, 36% indicated it was self-initiated and dismissed. More than half of BC survivors' reported a desire for lifestyle-related information and guidance. CONCLUSION BC survivors may not understand how their separate, yet cumulative, health issues can impact their CV risk. PRACTICE IMPLICATIONS Patient-provider communication on behavioral risk factor modification and CV risk is needed, particularly among at-risk subgroups such as AA and obese BC survivors, to improve BC and CV outcomes.
Collapse
Affiliation(s)
- Allison H Christian
- Department of Health Education and Behavioral Science, Rutgers, The State University, School of Public Health, Piscataway, NJ, United States; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States.
| | | | - Ana Barac
- MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States
| | - Suzanne M Miller
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Shawna V Hudson
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, United States
| |
Collapse
|
25
|
Hinyard L, Wirth LS. Race is a Strong Predictor of Receipt of a Written Survivorship Care Plan: Results from the National Health Interview Survey. J Community Health 2017; 42:1156-1162. [PMID: 28455672 DOI: 10.1007/s10900-017-0365-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to investigate the prevalence of receipt of written documentation of follow up care and of cancer treatments and to examine the predictors of receipt of such written documentation. Data from the 2010 National Health Interview Survey was used to identify individuals 18 years or older with a history of cancer. Binary and multinomial logistic regression were used to investigate patient-level variables associated with receipt of written documentation of cancer treatment, written advice about follow-up care, or both written documents. Patient-level variables included in the analysis were age, gender, region of residence, race/ethnicity, marital status, education level, insurance coverage, cancer type, employment status, and psychosocial support. Of the 1185 responses to the questions used to access receipt of a SCP, the prevalence of any receipt of a written documentation was 68%, where 30% obtained written advice only and 8% were provided a written treatment summary only; only 31% received both. Non-white race, cancer type, and psychosocial services were associated with increased odds of receiving written documentation. Patient-level characteristics are associated with receipt of care plan documentation. Further work needs to investigate the interaction of provider and patient-level characteristics. Understanding patient-level characteristics associated with receipt of written documentation may help uncover strategies for improved survivorship care plan implementation.
Collapse
Affiliation(s)
- Leslie Hinyard
- Saint Louis University Center for Health Outcomes Research, Saint Louis University Center for Interprofessional Education and Research, 3545 Lafayette Ave., Salus Center, Room 409, St. Louis, MO, 63104, USA. .,Saint Louis University Center for Health Outcomes Research, 3545 Lafayette Ave., Salus Center, 4th Floor, St. Louis, MO, 63104, USA.
| | - Lorinette S Wirth
- Saint Louis University Center for Health Outcomes Research, Saint Louis University Center for Interprofessional Education and Research, 3545 Lafayette Ave., Salus Center, Room 409, St. Louis, MO, 63104, USA
| |
Collapse
|
26
|
Grote S, Almstedt HC, Tarleton HP. Cardiometabolic Health Among Cancer Survivors: A 13-Week Pilot Study of a Combined Aerobic and Resistance Training Program. Oncol Nurs Forum 2016; 43:306-15. [PMID: 27105192 DOI: 10.1188/16.onf.306-315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore the feasibility of combined aerobic and resistance training (CART) as a safe method of improving cardiometabolic health among cancer survivors.
. DESIGN Descriptive and longitudinal pilot study for exercise intervention.
. SETTING University campus in Los Angeles, California.
. SAMPLE A multiethnic population of cancer survivors (N = 11) was recruited by convenience sampling and physician referral.
. METHODS Consenting participants were prescribed CART for one hour per day, three days per week for 13 weeks.
. MAIN RESEARCH VARIABLES Components of cardiometabolic health were measured, including resting heart rate (HRrest), blood pressure, body mass index, waist circumference, body fat percentage, and android fat percentage at baseline and after 13 weeks of training. Fasting blood glucose, insulin, adiponectin, leptin, tumor necrosis factor alpha, and C-reactive protein (CRP) also were assessed at baseline and after 13 weeks of training.
. FINDINGS More than half of the participants reported living with at least two other chronic diseases or conditions in addition to a cancer diagnosis. Five of six African American and Hispanic participants reported the presence of at least two risk factors for metabolic syndrome, compared to one of five Caucasian participants. After 13 weeks of training, participants experienced an average decrease in waist circumference. Decrease in waist circumference was associated with a decrease in CRP. A relationship also was suggested between number of exercise sessions attended and improvement in HRrest.
. CONCLUSIONS A CART intervention among cancer survivors should continue to be explored in a larger sample to establish efficacy and effectiveness at improving cardiometabolic health. Because of the higher risk of comorbidity among cancer survivors in comparison to cancer-free adults, improving cardiometabolic health is as important as monitoring cancer recurrence. A need exists for increased attention to the post-treatment cardiometabolic health of cancer survivors and also for examining potential cardiometabolic health disparities among non-Caucasian cancer survivors.
. IMPLICATIONS FOR NURSING CART may be a plausible alternative to reduce the risk of metabolic syndrome and improve cardiometabolic health among cancer survivors. Additional studies that continue to explore the efficacy and effectiveness of CART may provide more information to help nurses and physicians determine whether the cancer survivorship care plan should include an exercise-based alternative to intervene on cardiometabolic health.
Collapse
|
27
|
Dimitriadis I, Batsis M, Petrozza JC, Souter I. Racial Disparities in Fertility Care: an Analysis of 4537 Intrauterine Insemination Cycles. J Racial Ethn Health Disparities 2016; 4:169-177. [DOI: 10.1007/s40615-016-0215-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/09/2016] [Indexed: 01/19/2023]
|
28
|
Tabrizi FM. Health promoting behavior and influencing factors in Iranian breast cancer survivors. Asian Pac J Cancer Prev 2016; 16:1729-36. [PMID: 25773817 DOI: 10.7314/apjcp.2015.16.5.1729] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the associations among the internal health locus of control, depression, perceived health status, self efficacy, social support, and health-promoting behavior in Iranian breast cancer survivors and to determine influential variables. MATERIALS AND METHODS A predictive design was adopted. By convenient sampling the data of 262 breast cancer survivors in Iran were collected by questionnaires during 2014. Data were analyzed applying descriptive statistics, t-tests, one-way ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. RESULTS The internal health locus of control, depression, perceived health status, self efficacy, social support and undergoing chemotherapy all correlated significantly with the health-promoting lifestyle. Stepwise multiple regression analysis revealed that social internal health locus of control, depression, perceived health status, self efficacy and social support and chemotherapy accounted for about 39.8% of the variance in health promoting lifestyle. The strongest influence was social support, followed by self efficacy, perceived health status, chemotherapy and depression. CONCLUSIONS The results of the study clarifed the seriousness of social support, self efficacy, perceived health status and depression in determining the health-promoting lifestyle among Iranian breast cancer survivors. Health professionals should concentrate on these variables in designing plans to promoting a healthy lifestyle.
Collapse
Affiliation(s)
- Fatemeh Moghaddam Tabrizi
- Nursing and Midwifery Department, Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran E-mail :
| |
Collapse
|
29
|
Ryerson AB, Eheman C, Styles T, Rycroft R, Snyder C. Connecting the Dots: Linking the National Program of Cancer Registries and the Needs of Survivors and Clinicians. Am J Prev Med 2015; 49:S528-35. [PMID: 26590648 PMCID: PMC4656128 DOI: 10.1016/j.amepre.2015.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/24/2015] [Accepted: 08/31/2015] [Indexed: 12/14/2022]
Abstract
Cancer survivors, the medical community, public health professionals, researchers, and policymakers all need information about newly diagnosed cancer cases and deaths to better understand and address the disease burden. CDC collects cancer data on 96% of the U.S. population through the National Program of Cancer Registries. The National Program of Cancer Registries routinely collects data on all cancer occurrences, deaths, and the types of initial treatment received by the patients, and recently CDC has made advances in its cancer surveillance activities that have direct applicability to cancer survivorship research and care. This article examines CDC's innovative uses of the National Program of Cancer Registries infrastructure and data as a recruitment source for survivorship research studies and behavioral interventions; comparative effectiveness and patient-centered outcomes research; and the collection, consolidation, and dissemination of treatment summaries for cancer survivors and their providers. This paper also discusses long-term, idealistic plans for additional data linkages and sharing among public health, providers, and the cancer survivor through innovative concepts such as patient portals and rapid-learning health care.
Collapse
Affiliation(s)
- A Blythe Ryerson
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia.
| | - Christie Eheman
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Timothy Styles
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Randi Rycroft
- Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, Denver, Colorado
| | - Claire Snyder
- Division of General Internal Medicine, Johns Hopkins School of Medicine; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| |
Collapse
|
30
|
Abstract
OBJECTIVES To examine the significance of multimorbidity in breast cancer survivors, to explore multimorbidity in treatment decisions, and survivorship, and to consider multimorbidity assessment in clinical practice. DATA SOURCES Literature review; clinical practice guidelines. CONCLUSION Multimorbidity influences treatment decisions. Breast cancer survivors report greater multimorbidity compared with other cancer survivors. Multimorbidity increases with age; there may be racial and ethnic differences. Multimorbidity is associated with symptom burden, functional decline, low adherence to surveillance, and early retirement. IMPLICATIONS FOR NURSING PRACTICE Clinical practice guidelines do not refer to multimorbidity and patient outcomes. Comprehensive geriatric assessment combined with survivorship care plan may be considered.
Collapse
|
31
|
Contextual factors influencing health-related quality of life in African American and Latina breast cancer survivors. J Cancer Surviv 2015; 9:441-9. [PMID: 25576214 DOI: 10.1007/s11764-014-0420-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/06/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE This study explored the relationships between systemic- and individual-level contextual factors and health-related quality of life (HRQOL) in a cohort of African American and Latina breast cancer survivors (BCS). METHODS Baseline questionnaire data of 320 BCS who participated in a HRQOL psycho-educational intervention were abstracted from the parent study. Hierarchical regression analysis tested the independent effects of contextual factors on HRQOL. RESULTS HRQOL was higher in BCS who: were diagnosed at < stage 2 (b = -1.38, p < 0.05), expressed satisfaction with their health care (b = 0.20, p < 0.001), had fewer comorbidities (b = - 0.60, p < 0.001) and depressive symptoms (b = -0.30, p < 0.001), and practiced healthy diet and exercise habits (b = 0.02, p < 0.05). Demographic and cancer-related factors accounted for 14 % of the variance in HRQOL (F[6, 274] = 7.25, p < 0.001). The socio-cultural context (i.e., ethnicity, life stress, perceived social support) explained 20 % of the variance in HRQOL (FΔ[3, 271] = 27.32, p < 0.001). The health care system context contributed an additional 8 % to explaining HRQOL (FΔ[1, 270] = 34.88, p < 0.001). Health status and behavioral factors accounted for 18 % of the variance (FΔ[4, 266] = 29.55, p < 0.001). The full model explained 59 % of the variance in HRQOL (F[14, 266] = 27.76, p < 0.001). CONCLUSIONS HRQOL in ethnic minority BCS is multifaceted and is significantly influenced by cancer-related, socio-cultural, health care system, health status, and behavioral contextual factors. Therefore, survivorship research and practice must address broad multi-level domains to achieve equitable and optimal breast cancer outcomes. IMPLICATIONS FOR CANCER SURVIVORS To enhance HRQOL, survivors must be provided the know-how and support to maintain healthy lifestyle and self-management practices. Advocates must engage the care team to consider systemic factors, including life stress and community resources, to be more patient-centered.
Collapse
|
32
|
Highland KB, Hurtado-de-Mendoza A, Stanton CA, Dash C, Sheppard VB. Risk-reduction opportunities in breast cancer survivors: capitalizing on teachable moments. Support Care Cancer 2014; 23:933-41. [PMID: 25239599 DOI: 10.1007/s00520-014-2441-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE With advancements in detection and treatment, the number of breast cancer survivors is growing. To reduce mortality among survivors, tailored health-promotion programs are needed to combat comorbidities. However, the demand for such programs exceed that which is available for a vastly diverse population of survivors. The goal of the present study was to describe the prevalence of comorbidities in a group of breast cancer survivors and to examine associations between biological proximal factors of and the more distal individual-level factors on the number and types of comorbidities. METHODS In addition to medical chart reviews, breast cancer survivors (N = 369) from hospitals in two urban locations completed self-report measures. Bivariate analyses examined the relationship between distal and proximal predictors and the outcomes: number of comorbidities and comorbidity types. RESULTS Both proximal and distal factors were associated with comorbidities. African American, women with lower education attainment, and older women were more likely to be obese and have more comorbidities than their counterparts. In particular, they were more at risk for cardiovascular disease. Those who initiated hormonal therapy, chemotherapy, and radiation therapy were more likely to have comorbidities. Several psychosocial variables were related to proximal psychosocial factors. CONCLUSIONS The present findings highlight the need for targeted health-promotion treatments for breast cancer survivors, particularly for African Americans, those with lower education attainment, those who are obese, and those who may be older. Given the relationships between specific comorbidities and proximal psychosocial factors, future interventions may benefit from tailored approaches. IMPLICATIONS FOR CANCER SURVIVORS Tailored interventions for survivors may be more effective when accounting for factors associated with health-promotion engagement.
Collapse
Affiliation(s)
- Krista Beth Highland
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA,
| | | | | | | | | |
Collapse
|