COVID-19 perceptions, impacts, and experiences: a cross-sectional analysis among New Jersey cancer survivors

Sociodemographic, medical, health behavior, and psychosocial factors associated with COVID-19 diagnoses in the New Jersey cancer survivor cohort

BACKGROUND

Cancer survivors are more susceptible to contracting COVID-19. However, beyond race, age, and sex, less is known about other neighborhood and psychosocial factors contribute to this increased risk.

OBJECTIVE

The goal of this study was to examine the associations of individual and area-level social determinants of health (SDOH) measures, medical, lifestyle, and psychosocial factors and COVID-19 infection in a statewide cohort of cancer survivors in New Jersey.

METHODS

Survey data from 864 cancer survivors in New Jersey were collected from 2018 to 2022, which were merged with study participant data from the state of New Jersey on COVID-19 diagnoses in 2020, 2021, and 2022. We estimated adjusted odds ratios (aOR) for associations of COVID-19 diagnosis with individual-level factors (cancer type and stage, health behaviors, and psychosocial factors) and area-level SDOH [Social Vulnerability Index, Area Deprivation Index, and Index of Concentration at the Extremes (ICE) to quantify racialized deprivation vs. privilege based on income].

RESULTS

Cancer survivors born outside the US were more than twice as likely to contract COVID-19 compared to US-born survivors (aOR 2.29, 95% CI 1.01, 4.92). Compared to Quartile 4, residence in an area in Quartile 1 of racialized income ICE (i.e., predominantly Black, low income) was associated with higher odds of COVID-19 (aOR 2.15, 95% CI 0.98, 4.87). Retired survivors had lower odds of COVID-19 (aOR 0.39, 95% CI 0.19, 0.80) compared to those who were employed. Higher social well-being was associated with higher COVID-19 (aOR 1.07, 95% CI 1.02, 1.13). Type of cancer and cancer treatments received were not associated with the risk of COVID-19.

CONCLUSIONS

Immigrant status and increased racialized deprivation as measured by ICE for income were associated with COVID-19. These findings support evidence that individual and area-level SDOH measures contribute to increased risk of COVID-19 among cancer survivors.

Race-modified estimated glomerular filtration rate underestimates chronic kidney disease prevalence in Black patients undergoing partial and radical nephrectomy: Implications for surgical planning

Introduction

In estimated glomerular filtration rate equations (eGFR), the race multiplier (RM) yields greater eGFR values and may assign less severe chronic kidney disease (CKD) stages to black individuals. When deciding on appropriateness for partial nephrectomy (PN), patients with CKD are often considered a relative or absolute indication. We hypothesize that the eGFR RM may have ramifications for patients being counseled for radical nephrectomy (RN) versus PN to manage their renal tumor.

Methods

We utilized prospective and retrospective, IRB-approved single-center databases to select patients who underwent PN or RN between 2016 and 2022. Demographics, preoperative risk factors, preoperative eGFR, and surgical management were collected. Descriptive statistics and two-tailed difference of proportion tests compared the percentage of patients with CKD who underwent nephrectomy.

Results

This cohort included 1137 patients who underwent RN or PN, including 74 (6.5%) Black patients and 93.5% (n = 1063) non-Black patients. There was no statistically significant difference between the eGFR of Black and non-Black individuals using the Modification of Diet in Renal Disease equation (P = 0.24) or Chronic Kidney Disease Epidemiology Collaboration 2009 (CKD-EPI 2009) (P = 0.45); however, there was statistically significant difference in eGFR between sample populations when using CKD-EPI 2021 (P = 0.0055). Of the Black patient cohort, 16.2% of patients reclassified to a worse CKD class using CKD-EPI 2021, including 9.5% of Black patients reclassified to CKD3a or worse, and 14.6% of all patients (Black and non-Black) reclassified to a different CKD class under the CKD-EPI 2021 equation.

Conclusions

There are quantitative differences in the evaluation of eGFR when utilizing different equations that may impact clinical considerations and health equity outcomes for nephrectomy across racial groups.

Comparing patient-reported outcomes and lifestyle factors before and after the COVID-19 pandemic among Black and Hispanic breast cancer survivors in New Jersey

PURPOSE

The impact of the COVID-19 pandemic restrictions in the US since March 2020 on cancer survivorship among Black and Hispanic breast cancer (BC) survivors remains largely unknown. We aimed to evaluate associations of the pandemic with participant characteristics, patient-reported outcomes (PROs), and lifestyle factors among Black and Hispanic BC survivors in the Women's Circle of Health Follow-Up Study and the New Jersey BC Survivors Study.

METHODS

We included 447 Black (npre = 364 and npost = 83) and 182 Hispanic (npre = 102 and npost = 80) BC survivors who completed a home interview approximately 24 months post-diagnosis between 2017 and 2023. The onset of the pandemic was defined as March 2020. The association of the pandemic with binary outcomes was estimated using robust Poisson regression models.

RESULTS

Hispanic and Black BC survivors recruited after the onset of the pandemic reported higher socioeconomic status and fewer comorbidities. Black women in the post-pandemic group reported a higher prevalence of clinically significant sleep disturbance (prevalence ratio (PR) 1.43, 95% CI 1.23, 1.68), lower sleep efficiency, and lower functional well-being, compared to the pre-pandemic group. Hispanic women were less likely to report low health-related quality of life (vs. high; PR 0.62, 95% CI 0.45, 0.85) after the onset of the pandemic.

CONCLUSIONS

Ongoing research is crucial to untangle the impact of the pandemic on racial and ethnic minorities participating in cancer survivorship research, as well as PROs and lifestyle factors.

IMPLICATIONS FOR CANCER SURVIVORS

This study highlights the importance of considering the impact of the pandemic in all aspects of research, including the interpretation of findings.

Factors associated with health-related quality of life in a cohort of cancer survivors in New Jersey

BACKGROUND

Although there is extensive literature on correlates of health-related quality of life (HRQoL) among cancer survivors, there has been less attention paid to the role of socioeconomic disadvantage and survivorship care transition experiences in HRQoL. There are few large cohort studies that include a comprehensive set of correlates to obtain a full picture of what is associated with survivors' HRQ0L. This cohort study of recent cancer survivors in New Jersey aimed to explore the association between social determinants of health, health history, health behaviors, survivorship care experiences, and psychosocial factors in HRQoL.

METHODS

Eligible survivors were residents of New Jersey diagnosed with genitourinary, female breast, gynecologic, colorectal, lung, melanoma, or thyroid cancers. Participants completed measures of social determinants, health behaviors, survivorship care experiences, psychosocial factors, and HRQoL. Separate multiple regression models predicting HRQoL were conducted for each of the five domains (social determinants, health history, health behaviors, survivorship care experiences, psychosocial factors). Variables attaining statistical significance were included in a hierarchical multiple regression arranged by the five domains.

RESULTS

864 cancer survivors completed the survey. Lower global HRQoL was associated with being unemployed, more comorbidities, a less healthy diet, lower preparedness for survivorship, more unmet support needs, and higher fear about cancer recurrence. Two psychosocial factors, unmet support needs and fear of recurrence, played the most important role in HRQoL, accounting for more than 20% of the variance. Both unmet support needs and fear of recurrence were significant correlates of physical, functional, and emotional HRQoL domains.

CONCLUSIONS

Interventions seeking to improve cancer survivors' HRQoL may benefit from improving coordinated management of comorbid medical problems, fostering a healthier diet, addressing unmet support needs, and reducing survivors' fears about cancer recurrence.