Cancer detection, diagnosis, and treatment for adults with disabilities

A Pilot Test to Support Healthcare Providers in Promoting Vaccine Uptake Among Individuals With Intellectual and Developmental Disabilities

Individuals with intellectual and/or developmental disabilities encounter barriers to vaccine access, uptake, and confidence, leading to health inequities. These include barriers related to healthcare provider capacity to effectively address the social determinants of health, provide accessible needle procedures, and translate and disseminate inclusive public health information. The current study aimed to test the preliminary effectiveness of a virtual continuing medical education (CME) course on enhancing healthcare provider capacity to address these barriers. This CME was available free-of-charge online. Participants included 120 healthcare providers (physicians: 45%; nurses: 37%; and other learners: 18%) in internal medicine, family practice, and related disciplines. The CME-created based on video interviews with patients and providers-focused on factors that affect vaccine uptake/access/confidence (Module 1); strategies to increase vaccine receipt (Module 2); and inclusive public health communication (Module 3). The pre-post survey assessed self-reported understanding, confidence, and abilities. Following CME completion, learners were significantly more likely to report higher understanding, confidence, and abilities in responding to the social determinants of health (Module 1); addressing barriers to vaccine access/uptake/confidence (Module 2); and engaging in effective public health communication (Module 3). Findings support the utility of short-term healthcare provider trainings on this topic. Future research should evaluate longer-term impacts and identify opportunities to create standardized medical curricula for this population.

Discretionary exclusion criteria in oncology clinical trials and exclusion of people with psychiatric and cognitive disabilities

BACKGROUND

Clinical trial protocols often allow investigators discretion to determine whether individuals are eligible to participate.

OBJECTIVE

To examine the frequency and impact of discretionary eligibility criteria in oncology clinical trials, including whether they specifically target populations with psychiatric or cognitive disabilities for exclusion.

METHODS

We identified interventional Phase III and Phase IV oncology clinical trials on ClinicalTrials.gov starting between January 1, 2019, and December 31, 2023. Among these, we included trials with at least one US location, patient populations aged 18-65 or 65+, and a posted study protocol. We used descriptive statistics to capture prevalence of broad investigator discretion in eligibility criteria. We reviewed statements concerning discretionary eligibility criteria for text relating to psychiatric or cognitive disability, and we applied qualitative content analysis techniques to identify themes.

RESULTS

Ninety-six trials met inclusion criteria for this study. Of these, 82 (85.4 %) of trials allowed broad investigator discretion to determine eligibility. Content analysis revealed concerns about participants' safety (i.e., posing undue risk to patients), potential difficulties adhering to study protocols (e.g., because of patients' physical, psychiatric, or social condition), perceived ability to obtain informed consent, and completing assessments of patients to determine results of interventions. All trials required informed consent.

CONCLUSIONS

Most oncology clinical trials allow investigators broad discretion in determining the eligibility of individuals to participate. These discretionary criteria may particularly target persons with psychiatric or cognitive disabilities, excluding them from participating in clinical trials. Further research should examine whether certain rationales for excluding these populations are appropriate.

Breaking barriers: a commentary on research gaps in cancer and depression among individuals with intellectual disabilities

The European Commission's Strategy for the Rights of Persons with Disabilities 2021-2030 aims to ensure equal opportunities and rights for all individuals, including those with intellectual disabilities. People with intellectual disabilities are often underrepresented in cancer prevention and screening policies, leading to disparities in health outcomes and early mortality. The intersection of intellectual disability, cancer, and depression represents an underexplored area in healthcare research. Individuals with intellectual disability diagnosed with both cancer and depression face compounded challenges impacting their quality of life, proper access to medical care, and treatment outcomes. To address these gaps in the systems globally, a focused effort is indispensable to understand their unique needs and better tailor care strategies for this target group. Therefore, this commentary outlines the challenges in researching individuals with intellectual disabilities who have a dual diagnosis of cancer and depression. Challenges include providing informed consent, ethical researcher-participant relationships, and maintaining confidentiality and autonomy. Strategies for improvement include creating accessible procedures, raising awareness, and involving individuals with intellectual disabilities in research ethics committees.

Cervical Cancer Screening in Women With Physical Disabilities

Importance

Cervical cancer screening is a crucial public health intervention, but screening disparities exist for women with physical disabilities (WWPD).

Objective

To explore the experiences of WWPD with both traditional speculum examination-based screening and at-home self-sampling for cervical cancer screening.

Design, Setting, and Participants

This qualitative study enrolled 56 WWPD to test self-sampling kits, provide feedback via a survey, and participate in a qualitative interview. An interprofessional team conducted semistructured interviews with 16 key informants and 40 pilot participants for 56 WWPD from November 1, 2021, through April 30, 2023. All completed a self-administered quantitative survey. Key informants' experiences with 4 self-sampling devices helped determine which 2 self-sampling kits would be offered to participants in a pilot study.

Main Outcomes and Measures

A coding scheme was developed to represent inductive codes generated through preliminary coding and deductive codes representing domains from the Theoretical Domains Framework. This coding scheme was used to conduct a 2-pass thematic analysis.

Results

Of the 56 WWPD (mean [SD] age, 45.4 [9.1] years) who participated in the study, 28 (50.0%) were up to date with cervical cancer screening. Participants described accessibility barriers and clinician ableism that made speculum-based in-office examinations difficult, leading some participants to delay or avoid screening. In contrast, participants described self-screening as more comfortable and convenient, regardless of whether they prefer future speculum-based screening. Their responses also allowed for the exploration of how screening preferences may impact future screening behavior.

Conclusions and Relevance

Interviews with WWPD suggested that access to self-sampling screening options would be more comfortable for cervical cancer screening participation. Understanding participants' experiences with self-sampling devices generates insights into improving screening experiences for WWPD.

Disabilities and eating disorders: A theoretical model and call for research

OBJECTIVE

There is an urgent need for research on eating disorders among individuals with disabilities. This paper highlights the lack of research on the relationships between disabilities and EDs, despite their common convergence.

METHOD

In this paper, we aim to 1) highlight the need for further research investigating the relationships between disability status and EDs, 2) describe existing frameworks for conceptualizing disability, 3) utilize such frameworks to propose a novel theoretical model of ED/disability relationships and related sociocultural factors and 4) identify future directions for research in this area.

RESULTS

We propose a multidimensional theoretical model of the relationships between EDs and disabilities. Further, we describe how these relationships are likely influenced by a system of individual factors (e.g., disability (in)visibility, food access, and self-identification) and sociocultural factors (e.g., ableism/discrimination and weight stigma).

DISCUSSION

Scholars are encouraged to test our proposed model and further investigate experiences of disability and ED co-occurrence with participatory research and mixed-methods designs. ED prevention and screening programs, as well as treatment access and efficacy, need to be evaluated for disabled populations. Disability should also be routinely collected as a demographic across studies, and ED measures should be validated and/or developed for individuals with disabilities.

Frequency of Missing TNM Stage Data for Adults With Intellectual or Developmental Disabilities in a Provincial Cancer Registry-A Brief Report

BACKGROUND

Adults with intellectual or developmental disability (IDD) are at higher risk for incomplete cancer staging.

AIM

To compare unknown stage data between those with and without IDD.

MATERIALS AND METHODS

We used the Ontario Cancer Registry linked to administrative health data between 2007 and 2019.

RESULTS

Adults with IDD diagnosed with breast, colorectal, and lung cancer were 1.94 (95% CI 1.52-2.47), 1.90 (95% CI 1.63-2.21), and 2.17 (95% CI 1.86-2.54) times more likely to have unknown cancer stage at diagnosis, relative to those without IDD.

DISCUSSION

The absence of stage data has person-level and population-level implications. At the individual level, if stage data are not simply missing from the registry but reflect incomplete or absent diagnostic or staging procedures, this may represent barriers for adults with IDD in receiving curative treatment. At the population level, research using inaccurate or incomplete stage data may lead to unrepresentative health and social system policy decisions.

CONCLUSION

A better understanding of the cancer diagnostic interval for adults with IDD is needed to develop interventions.

Cervical Cancer Screening Uptake Among Women with Disabilities: Findings from a Cross-Sectional Study in Chile

The Papanicolaou (Pap) test is one of the most effective methods for cervical cancer screening. However, women with disabilities are less likely to be screened. The objective of this study is to determine whether there is a difference in Pap test utilisation between women with and without disabilities and to analyse the demographic, socioeconomic, and health-related characteristics associated with Pap test uptake among women with disabilities in Chile. Data from the 2022 National Socioeconomic Characterization Survey were analysed, and 71,989 women between 18 and 75 years of age were included. The dependent variable was Pap test utilisation, and the exposure variable was disability. We used logistic regressions to control for demographic, socioeconomic, and health-related covariates. The results showed that women with disabilities were less likely to undergo a Pap test compared to those without disabilities. Characteristics such as being married, being aged between 25 and 64 years, and having secondary or tertiary education increased the likelihood of Pap test utilisation. Conversely, being single, having received special education, and being inactive decreased these odds. Effective public health policies are needed that will increase Pap test utilisation for all population subgroups, including women with disabilities and, therefore, promote health equity.

Effect of adaptive sports on quality of life in individuals with disabilities who use wheelchairs: a mixed-methods systematic review

PURPOSE

Adaptive sports participation has been shown to improve quality of life (QoL) in individual with disabilities. However, inconsistent results in various domains of QoL exist in the literature. The objective of this mixed-methods systematic review is to identify and synthesize evidence from quantitative and qualitative studies on the effect of adaptive sports on QoL in individuals with disabilities who use wheelchairs for mobility.

METHODS

A systematic literature review of quantitative, qualitative, and mixed-methods research on the effect of adaptive sports on QoL was conducted on five databases (Scopus, Web of Science, PsycINFO, Medline, and PubMed). Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool.

RESULTS

This review identified 4 key findings from 41 studies, including 31 quantitative and 10 qualitative studies. First, individuals with disabilities using wheelchairs for mobility who actively engaged in adaptive sports tend to report higher QoL scores compared with those who were inactive or did not participate. Second, the relationship between the duration of regular participation in adaptive sports and QoL scores exhibited inconsistent results. Third, a multi-component adaptive sports program demonstrates the potential to further improve QoL scores. Last, qualitative investigations reveal that participation in adaptive sports positively influences various domains of well-being in wheelchair users, including encompassing physical and emotional well-being, interpersonal relationships, material well-being, personal development, self-determination, and social inclusion.

CONCLUSION

This review provides a comprehensive relationship between adaptive sports participation and QoL of wheelchair users. This study identifies the value of multi-component interventions and demonstrates the diverse positive influences of adaptive sports on well-being.

Enhancing nursing students' communication skills with deaf patients: Workshop impact on nursing education programs

BACKGROUND

Nursing students require education on effective communication with patients to fulfill their roles as future healthcare providers. Ensuring inclusive patient care requires addressing this educational gap.

PURPOSE

This study assesses the impact of workshops on nursing students' communication strategies with Deaf and hard-of-hearing patients.

METHODS

A cross-sectional survey was conducted among nursing students before and after participating in workshops conducted by Deaf instructors from the non-profit association Maagalei Shema. Data was collected from January 2023 to March 2024 and analyzed using SPSS software.

FINDINGS

Results indicate that the workshops significantly improved participants' communication strategies, with 82.48% reporting enhanced abilities post-workshop. The use of communication tools, including professional interpreters, increased following the workshops.

DISCUSSION

Workshops offer an effective approach to enhancing healthcare workers' communication with Deaf and hard-of-hearing patients. These findings underscore the importance of incorporating experiential learning opportunities into nursing education to optimize patient interactions and improve healthcare outcomes.

Cancer Prevention in Adults with Intellectual Disabilities: A Systematic Literature Review of Caregiver Perspectives in Institutional and Home Care Settings

Background: Individuals with intellectual disabilities (IDs) face unique challenges in accessing cancer prevention measures. Caregivers play a crucial role in facilitating these measures, yet their perspectives are under-researched. Methods: This systematic literature review explores caregiver perspectives on cancer prevention for adults with IDs in institutional and home care settings, aiming to understand their roles, knowledge, and challenges. Thirteen articles from the UK, the USA, Canada, and Ireland were analyzed through thematic synthesis. Four overarching themes were identified: breast cancer screening perspectives, caregivers' knowledge and barriers to cancer prevention, caregivers' perspectives, and cultural context and decision-making. Results: Caregivers, including healthcare professionals and family members, are essential in facilitating breast cancer screening for individuals with IDs. Challenges include explaining screening procedures, limited awareness, and logistical barriers, highlighting the need for targeted educational interventions. Disparities in access underscore the necessity for comprehensive training programs. Healthcare professionals' perspectives reveal existing disparities and suggest interventions for improved accessibility and understanding. Cultural context influences decision-making, emphasizing the importance of culturally sensitive care. The role of family caregivers in decision-making necessitates empowering and supporting them through tailored interventions. Conclusions: This review provides insights into the challenges and opportunities in cancer prevention for individuals with IDs, suggesting the need for educational interventions, training programs, and systemic changes to address disparities. It lays the groundwork for future research and the development of holistic and inclusive strategies in this critical healthcare domain.

Exploring Ethical Dimensions in Neuropalliative Care

Neurologic illnesses can be challenging to diagnose, involve changes in consciousness, and are often complicated by prognostic uncertainty. These disorders can affect how individuals interact with their environment, and as a result, many ethical concerns may arise related to their medical care. Key ethical issues in neuropalliative care include shared decision-making, evolving autonomy and capacity, best interest and harm principles, beneficence and nonmaleficence, futile and inappropriate care, justice and equity, and ableism. The four core principles of medical ethics, beneficence, nonmaleficence, justice, and autonomy, are foundational in considering approaches to these ethical challenges. Shared decision-making is rooted in the principle of autonomy. Evolving autonomy and capacity evoke autonomy, beneficence, and nonmaleficence. The best interest and harm principles are rooted in beneficence and nonmaleficence. Questions of futility and inappropriate care are founded in the principles of nonmaleficence, autonomy, and justice. Ableism invokes questions of nonmaleficence, autonomy, and justice. Practitioners of neurology will encounter ethical challenges in their practice. Framing decisions around the core ethical principles of beneficence, nonmaleficence, autonomy, and justice will help clinicians navigate challenging situations while acknowledging and respecting each patient's individual story.

Evaluating differences in receipt of survivorship care plan among cancer survivors with and without disabilities

INTRODUCTION

Despite the role of the Survivorship Care Plan (SCP) in facilitating treatment adherence, research on SCP receipt among cancer survivors with disabilities remains limited. Thus, our study investigated the association between SCP receipt and disability count among cancer survivors.

METHODS

We analyzed cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System, Cancer Survivorship: Course of Treatment module. The final sample included 2271 respondents with self-reported cancer history. The outcome was self-reported SCP receipt (0 = did not receive SCP, 1 = received written summary or follow-up care instructions, and 2 = received SCP-both). Independent variable was disability counts, comprised of six types: hearing, vision, cognition, mobility, self-care, and independent living difficulties. Disability count was categorized into 0 = none, 1 one disability, 2 = two disabilities, and 3 =  ≥ 3 disabilities. We conducted weighted descriptive statistics and multinomial multivariable logistic regression.

RESULTS

The sample was mostly White (70.62%), female (59.42%), and aged ≥ 65 (54.88%). About 57% reported no disability, 20.89% reported 1-disability, 11.03% 2-disabilities, and 11.47% ≥ 3 disabilities. Mobility issues were the most common disability (26.86%), while self-care difficulties were the least common (6.40%). About 12.12% of cancer survivors did not receive SCP, 35.03% received either treatment summaries or follow-up care instructions, and 52.84% received SCP. Compared to those without disability, survivors with ≥ 3 disabilities had lower odds of receiving SCP (AOR 0.44, 95% CI 0.22-0.88, p = 0.022).

CONCLUSIONS

This study suggests disparities in SCP receipt by disability count. Addressing such disparities can promote treatment adherence and reduction of missed follow-up.

Population-based cancer incidence and mortality rates and ratios among adults with intellectual disabilities in Scotland: a retrospective cohort study with record linkage

: Objective : To provide contemporary data on cancer mortality rates within the context of incidence in the population with intellectual disabilities. : Methods : Scotland's 2011 Census was used to identify adults with intellectual disabilities and controls with records linked to the Scottish Cancer Registry and death certificate data (March 2011-December 2019). The control cohort without intellectual disabilities and/or autism were used for indirect standardisation and calculation of crude incident rates/crude mortality rates, and age-sex standardised incident rate ratios/standardised mortality ratios (SIR/SMR), with 95% CIs. : Results : Adults with intellectual disabilities were most likely diagnosed cancers of digestive, specifically colorectal (14.2%), lung (9.3%), breast (female 22.9%), body of the uterus (female 9.3%) and male genital organs (male 17.6%). Higher incident cancers included metastatic cancer of unknown primary origin (female SIR=1.70, male SIR=2.08), body of uterus (female SIR=1.63), ovarian (female SIR=1.59), kidney (female SIR=1.85) and testicular (male SIR=2.49). SMRs were higher, regardless of a higher, similar or lower incidence (female SMR=1.34, male SMR=1.07). Excess mortality risk was found for colorectal (total SMR=1.54, male SMR=1.59), kidney (total SMR=2.01 u, female SMR=2.85 u), female genital organs (SMR=2.34 (ovarian SMR=2.86 u, body of uterus SMR=2.11), breast (female SMR=1.58) and metastatic cancer of unknown primary origin (female SMR=2.50 u, male SMR=2.84). : Conclusions : Adults with intellectual disabilities were more likely to die of cancer than the general population. Reasons for this may include later presentation/diagnosis (so poorer outcomes), poorer treatment/compliance or both. Accessible public health approaches are important for people with intellectual disabilities, and healthcare professionals need to be aware of the different cancer experiences faced by this population.

Demographic, health and socioeconomic characteristics related to lung cancer diagnosis: a population analysis in New South Wales, Australia

Background

Lung cancer is a major cause of health loss internationally, and in Australia. Most of that loss is inequitably concentrated among vulnerable or disadvantaged people and amenable to prevention and earlier detection. In response, best practice lung cancer care considers peoples’ background, circumstances and care needs. Comprehensive, person level descriptions of demographic, health and discrete socio-economic disadvantage related factors are therefore required to inform best practice. We examine population wide correlations of demographic, health and socioeconomic characteristics with lung cancer diagnosis for use in cancer control programs, including screening.

Methods

A study of 5,504,777 (89.9%) adults living in New South Wales and participating in Australia’s Census in August 2016 with subsequent follow-up to the end of 2018. The Australian Bureau of Statistics’ (ABS) person-level integrated data asset linked census records with the NSW population cancer registry which includes primary site. Our study compared census participants who did not experience cancer in the follow-up period with those diagnosed with lung cancer, (n = 6160 and ICD10 C33-34). Outcomes are expressed as the adjusted relative odds (aOR) of incident lung cancer among adults in the community and measured using multi-variable logistic regression models. Validated ABS methods informed categorisation of social and economic variables.

Results

Multivariable comparison of those with lung cancer and those without a first cancer diagnosis (3276 lung cancers among 2,484,145 males; 2884 lung cancers among 2,944,148 females) showed associations with increasing age, varying ancestry, living alone (aOR = 1.30 95% CI 1.19–1.42 males; 1.24 95% CI 1.14–1.35 females), number of health conditions medicated, less than Year 12 education (aOR = 1.40 95% CI 1.30–1.51 males; 1.37 95% CI 1.27–1.48 females) and housing authority rental (aOR = 1.69 95% CI 1.48–1.94 males; 1.85 95% CI 1.63–2.11 females). Additional associations occurred among males with low income, disabilities before age 70, those unemployed and labouring occupations. As numbers of characteristics increased, so did the likelihood of lung cancer.

Conclusion

We provided a population wide description of characteristics relevant to lung cancer diagnosis. Deeper knowledge of these characteristics inform continuing development of lung cancer programs in prevention (e.g. tobacco control) and detection (e.g. lung cancer screening), then help prioritise targeted delivery of those programs.

Addressing Ableism in Physician Well-Being Planning

This Viewpoint discusses the importance of physician well-being for optimizing patient care and current efforts to improve physician well-being, describes how structural ableism affects the well-being of physicians with disabilities, and calls for further efforts to address ableism in the health care workforce.

Predictors of stool deoxyribonucleic acid test use in the United States: Implications for outreach to under-resourced populations

OBJECTIVE

Although colorectal cancer screening (CRCS) is a public health priority, uptake is suboptimal in under-resourced groups. Noninvasive modalities, including stool deoxyribonucleic acid (sDNA) testing, may mitigate economic, geographic, cultural, or impairment-related barriers to CRCS. We assessed use of sDNA testing and other CRCS modalities in U.S. residents, comparing subgroups defined by several social determinants of health (SDOH).

METHODS

A nationally representative sample of community-dwelling respondents aged 50-75 years self-reported use of CRCS modalities in the 2020 Behavioral Risk Factor Surveillance System Survey. Statistical analyses assessed up-to-date screening status and choice of modality in the recommended screening interval.

RESULTS

Of 179,833 sampled respondents, 60.8% reported colonoscopy, 5.7% sDNA testing, 5.5% another modality. The rate of up-to-date screening was 72.0% overall and negatively associated with Hispanic ethnicity (63.6%), lower educational and annual income levels (e.g.,

CONCLUSIONS

Under-resourced persons were more likely than better-resourced persons to access sDNA testing, possibly offsetting screening barriers in some groups. Findings suggest opportunities to increase CRCS with heightened communication about sDNA testing to those who may experience difficulty accessing other modalities.

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Key Words

• Behavioral Risk Factor Surveillance System
• Cancer screening
• Colonoscopy
• Colorectal cancer
• Colorectal cancer screening
• Health disparities
• Social determinants of health
• Stool deoxyribonucleic acid

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MESH Headings

• Humans
• Male
• Middle Aged
• Female
• Aged
• United States
• Feces/chemistry
• Colorectal Neoplasms/diagnosis
• Early Detection of Cancer/statistics & numerical data
• Behavioral Risk Factor Surveillance System
• DNA/analysis
• Colonoscopy/statistics & numerical data
• Mass Screening/statistics & numerical data
• Social Determinants of Health

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Affiliation(s)

Kathleen A Fairman Midwestern University College of Pharmacy, Glendale Campus, 19555 North 59(th) Avenue, Glendale, AZ 85308, United States of America.
Sarah T Lira Veterinary Pharmacy Resident, University of Illinois Urbana-Champaign, At the time the research was conducted, Dr. Lira was a PharmD student at the Midwestern University College of Pharmacy, Glendale Campus., 1008 West Hazelwood Drive, Urbana, IL 61802, United States of America.

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Comparative analysis of genetic testing utilization rates among people with and without disabilities in South Korea from 2016 to 2019, focusing on malignant neoplasms: A national population-based study

INTRODUCTION

Oncogene testing is widely used to detect or direct cancer treatments. Compared to people without disabilities, people with disabilities in Korea have a lower cancer incidence rate but a fivefold higher cancer mortality rate, implying delayed detection.

METHODS

We used an administrative database combining disability status and care utilization to analyze every case of cancer-related genetic testing paid for by the National Health Insurance Services of Korea between 2016 and 2019. We first compared percentages of individuals who had taken a registered genetic test by their disability statuses. We then compared the most frequently utilized tests between individuals with and without disabilities.

RESULTS

Korean citizens, 175,000 in total, underwent at least one of the 192 registered cancer-related genetic tests between 2016 and 2019. People with disabilities utilized these genetic tests at higher rates than those without disabilities, regardless of sex or age. Among people aged ≥40 years, lung and colorectal cancer-related tests were most frequently utilized, regardless of disability status.

CONCLUSION

Although the cancer-related genetic test uptake rate is higher among people with disabilities than among those without disabilities, it is still possible that information on these tests is not as readily available to people with disabilities. Therefore, it is imperative for the government to actively devise strategies to enhance national cancer screening rates among people with disabilities.

Breast (female), colorectal, and lung cancer survival in people with intellectual or developmental disabilities: A population-based retrospective cohort study

OBJECTIVES

Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). There is little empirical evidence documenting survival or comparing outcomes to those without IDD. This study investigated the association between IDD and cancer survival among adults with breast (female), colorectal, or lung cancer.

METHODS

A population-based retrospective cohort study was conducted in Ontario, Canada, with routinely collected data. Patients with breast, colorectal, or lung cancer were included (2007‒2019). IDD status before cancer was determined using an established administrative data algorithm. The outcomes of interest included death from any cause and death from cancer. Cox proportional hazards models and competing events analyses using multivariable cause-specific hazards regression were completed. Analyses were stratified by cancer type. Interactions with age, sex, and stage at diagnosis, as well as sensitivity analyses, were completed.

RESULTS

The final cohorts included 123,695 breast, 98,809 colorectal, and 116,232 lung cancer patients. Individuals with IDD experienced significantly worse survival than those without IDD. The adjusted hazard ratios of all-cause death were 2.74 (95% CI 2.41‒3.12), 2.42 (95% CI 2.18‒2.68), and 1.49 (95% CI 1.34‒1.66) times higher for breast, colorectal, and lung cancer patients with IDD relative to those without. These findings were consistent for cancer-specific deaths. With few exceptions, worse survival for people with IDD persisted regardless of stage at diagnosis.

CONCLUSION

People with IDD experienced worse cancer survival than those without IDD. Identifying and intervening on the factors and structures responsible for survival disparities is imperative.

Cancer risk-factor and symptom awareness among adults with intellectual disabilities, paid and unpaid carers, and healthcare practitioners: a scoping review

BACKGROUND

The physical health of people with intellectual disabilities (ID) has been identified as an area of ongoing concern and priority. Research has increasingly focused on cancer, with studies indicating that people with ID are at an increased risk of cancer and of mortality, compared with the general population. This review aims to systematically identify and synthesise the published academic literature exploring cancer risk-factor and symptom awareness among people with IDs, carers and healthcare professionals.

METHODS

In line with Arksey and O'Malley's (2005) framework for scoping reviews, five incremental stages were followed: (1) identifying research question, (2) identifying relevant studies, (3) study selection, (4) extracting and charting of data, and (5) collating, summarising and reporting results. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-Scr).

RESULTS

The search strategy identified 352 records, 16 records met all eligibility criteria and were included for review. The studies address a range of areas including knowledge and awareness of cancer risk-factors and symptoms and interventions to promote awareness of cancer.

CONCLUSIONS

Cancer risk-factor and symptom awareness is low among adults with ID, paid and unpaid carers and healthcare practitioners (HCPs). Theoretically underpinned, co-designed tools and interventions to improve awareness are lacking. There is uncertainty surrounding how to best support people with ID in raising cancer awareness, even within the professional healthcare environment. There is a predominance of research on breast cancer awareness. Future studies focusing on other cancers are needed to build a complete picture of awareness among adults with IDs, paid and unpaid carers, and HCPs.

Investigating inequalities in cancer staging and survival for adults with intellectual or developmental disabilities and cancer: A population-based study in Manitoba, Canada

BACKGROUND

Cancer is a leading cause of death among adults living with intellectual or developmental disabilities (IDD). However, few epidemiological studies exist worldwide quantifying inequalities in cancer stage at diagnosis and survival for people with IDD relative to those without IDD.

METHODS

A population-based, retrospective cohort study was conducted using provincial health and social administrative data in Manitoba, Canada. Adults (≥18 years) with a cancer diagnosis between 2004 and 2017 were included. Lifetime IDD was identified before the cancer diagnosis using an established algorithm. Modified Poisson regression with robust error variance was used to estimate the association between IDD status and metastatic cancer at diagnosis. Multivariable Cox proportional hazards analyses were used to the effect of IDD on overall survival following the cancer diagnosis.

RESULTS

The staging and prognosis cohorts included 62,886 (n = 473 with IDD) and 74,143 (n = 592 with IDD) cancer patients, respectively. People living with IDD were significantly more likely to be diagnosed with metastatic cancer and die following their cancer diagnosis compared to those without IDD (RR=1.20; 95 % CI 1.05-1.38; HR= 1.53; 95 % CI 1.38-1.71). Significant heterogeneity by sex was identified for cancer survival (p = 0.005).

DISCUSSION

People with IDD had more advanced cancer stage at diagnosis and worse survival relative to those without IDD. Identifying and developing strategies to address the factors responsible that contribute to these disparities is required for improving patient-centred cancer care for adults with IDD.

Disparities of health expenditure associated with the experience of admission in long-term care hospital among patients with colorectal cancer in South Korea: A generalized estimating equation

With rising concerns about the functional role of long-term care hospitals in the Korean medical system, this study aimed to observe the experience of admission in the long-term care hospitals and their association with medical expenditures among patients with colorectal cancer, and to investigate disparities among vulnerable populations. Data were obtained from the National Health Insurance Senior Cohort Database in South Korea for the period 2008-2019. With 6,305 patients newly diagnosed with colorectal cancer between 2008 and 2015, we conducted a regression analysis using the Generalized Estimating Equation model with gamma distribution to investigate the association between health expenditure and the experience of long-term care hospitals. We also explored the interaction effect of disability or income, followed by subgroup analysis. Among patients who received care at long-term care hospitals, the health expenditure within one year and five years after the incidence of colorectal cancer was found to be higher than in those who did not receive such care. It was observed that the low-income and disabled groups experienced higher disparities in health expenditure. The rise in health expenditure highlights importance for functional improvement, aligning with these initial purpose of long-term care hospitals to address the growing healthcare needs of the elderly population and ensure efficient healthcare spending, of long-term care hospitals. To achieve this original intent, it is imperative for government initiatives to focus on reducing quality gaps in long-term care hospital services and addressing cost disparities among individuals with cancer, including those with disabilities or low-income.

Do people with disabilities experience disparities in cancer care? A systematic review

BACKGROUND

Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic.

METHODS

A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding.

RESULTS

Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care.

DISCUSSION

Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.

What is ethically required to adapt to intellectual disability in cancer care? A case study of testicular cancer management

BACKGROUND

People with intellectual disability who require cancer services face several barriers and inequities, including delayed or unrecognised cancer diagnosis and inadequate attention paid to their specific concerns, needs and preferences about care.

METHODS

In this case report, we present a case report of a 33-year-old male with severe intellectual disability requiring treatment for metastatic testicular cancer. The patient's intellectual disability required major adjustments to the delivery of chemotherapy. We also describe the involvement of a clinical ethics committee to analyse the ethical pros and cons of different treatment options for this patient, and to facilitate discussions about collaboration and communication required, between different clinical teams, and with the patient's family and carers.

RESULTS AND CONCLUSIONS

We suggest this level of clinical and ethical deliberation sets the bar for what is required for healthcare services to be inclusive of and accessible for all people, especially those with intellectual disability.

Impairment in Activities of Daily Living Assessed by the Barthel Index Predicts Adverse Oncological Outcomes After Radical Cystectomy for Bladder Cancer

INTRODUCTION

We tested the association between functional impairment in activities of daily living (ADL) assessed through the Barthel Index (BI), and oncological outcomes following radical cystectomy (RC) for bladder cancer (BCa).

PATIENTS AND METHODS

We retrospectively analyzed data of 262 clinically nonmetastatic BCa patients, who underwent RC between 2015 and 2022, with available follow-up. According to preoperative BI, patients were divided in 2 groups: BI ≤90 (moderate/severe/total dependency in ADL) versus BI 95 to 100 (slight dependency/independency in ADL). Kaplan-Meier plots compared disease recurrence (DR)-, cancer-specific mortality (CSM)-, and overall mortality (OM)-free survival according to established categories. Multivariable Cox regression models tested the BI as an independent predictor of oncological outcomes.

RESULTS

According to the BI, the patient cohort was distributed as follows: 19% (n = 50) BI ≤90 versus 81% (n = 212) BI 95-100. Compared to patients with BI 95 to 100, patients with BI ≤90 were less likely to receive intravesical immuno- or chemotherapy (18% vs. 34%, p = .028), and more frequently underwent less complex urinary diversion as ureterocutaneostomy (36% vs. 9%, p < .001), or harbored muscle-invasive BCa at final pathology (72% vs. 56%, p = .043). In multivariable Cox regression models adjusted for age, ASA physical status score, pathological T and N stage, and surgical margins status, BI ≤90 independently predicted higher DR (HR [hazard ratio]:2.00, 95%CI [confidence interval]:1.21-3.30, p = .007), CSM (HR:2.70, 95%CI:1.48-4.90, p = .001), and OM (HR:2.09, 95%CI:1.28-3.43, p = .003).

CONCLUSION

Preoperative impairment in ADL was associated with adverse oncological outcomes following RC for BCa. The integration of the BI into clinical practice may improve the risk assessment of BCa patients candidates to RC.

Calling on the USPSTF to Address Ableism and Structural Ableism

In this Viewpoint, the authors urge the USPSTF to undertake a comprehensive effort to ensure its recommendations systematically consider the effects of ableism and structural ableism on individuals with disability.

Disparities in breast cancer among patients with disabilities: care gaps, accessibility, and best practices

Pronounced disparities exist in detecting and treating breast cancer in women with disabilities, leading to cancer detection at advanced stages. This paper provides an overview of disparities for women with disabilities related to breast cancer screening and care, primarily focusing on clinically significant mobility disabilities. Current care gaps include screening barriers related to accessibility and inequitable treatment options, with race and ethnicity, socioeconomic status, geographic location, and disability severity factors mediating the disparities for this population. The reasons for these disparities are myriad and stem from both system-level deficiencies and individual-level clinician bias. Although structural changes are warranted, individual healthcare professionals must also be incorporated into the requisite change. Intersectionality is critical to disparities and inequities and should be central to any discussion of strategies for improving care for people with disabilities, many of whom have intersectional identities. Efforts to reduce screening rate disparities for breast cancer in women with mobility-related disabilities should start with improving accessibility through removing structural barriers, establishing comprehensive accessibility standards, and addressing healthcare professional bias. Future interventional studies are needed to implement and assess the value of programs to improve breast cancer screening rates in women with disabilities. Increasing the representation of women with disabilities in clinical trials may provide another avenue for reducing treatment disparities because these trials often provide breakthrough treatment to women with cancer diagnosed at later stages. Ultimately, attention to the specific needs of patients with disabilities should be improved across the United States to promote inclusive and effective cancer screening and treatment.

Changes in cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic in the USA: a cross-sectional nationwide assessment

BACKGROUND

The emergence of COVID-19 disrupted health care, with consequences for cancer diagnoses and outcomes, especially for early stage diagnoses, which generally have favourable prognoses. We aimed to examine nationwide changes in adult cancer diagnoses and stage distribution during the first year of the COVID-19 pandemic by cancer type and key sociodemographic factors in the USA.

METHODS

In this cross-sectional study, adults (aged ≥18 years) newly diagnosed with a first primary malignant cancer between Jan 1, 2018, and Dec 31, 2020, were identified from the US National Cancer Database. We included individuals across 50 US states and the District of Columbia who were treated in hospitals that were Commission on Cancer-accredited during the study period. Individuals whose cancer stage was 0 (except for bladder cancer), occult, or without an applicable American Joint Committee on Cancer staging scheme were excluded. Our primary outcomes were the change in the number and the change in the stage distribution of new cancer diagnoses between 2019 (Jan 1 to Dec 31) and 2020 (Jan 1 to Dec 31). Monthly counts and stage distributions were calculated for all cancers combined and for major cancer types. We also calculated annual change in stage distribution from 2019 to 2020 and adjusted odds ratios (aORs) using multivariable logistic regression, adjusted for age group, sex, race and ethnicity, health insurance status, comorbidity score, US state, zip code-level social deprivation index, and county-level age-adjusted COVID-19 mortality in 2020. Separate models were stratified by sociodemographic and clinical factors.

FINDINGS

We identified 2 404 050 adults who were newly diagnosed with cancer during the study period (830 528 in 2018, 849 290 in 2019, and 724 232 in 2020). Mean age was 63·5 years (SD 13·5) and 1 287 049 (53·5%) individuals were women, 1 117 001 (46·5%) were men, and 1 814 082 (75·5%) were non-Hispanic White. The monthly number of new cancer diagnoses (all stages) decreased substantially after the start of the COVID-19 pandemic in March, 2020, although monthly counts returned to near pre-pandemic levels by the end of 2020. The decrease in diagnoses was largest for stage I disease, leading to lower odds of being diagnosed with stage I disease in 2020 than in 2019 (aOR 0·946 [95% CI 0·939-0·952] for stage I vs stage II-IV); whereas, the odds of being diagnosed with stage IV disease were higher in 2020 than in 2019 (1·074 [1·066-1·083] for stage IV vs stage I-III). This pattern was observed in most cancer types and sociodemographic groups, although was most prominent among Hispanic individuals (0·922 [0·899-0·946] for stage I; 1·110 [1·077-1·144] for stage IV), Asian American and Pacific Islander individuals (0·924 [0·892-0·956] for stage I; 1·096 [1·052-1·142] for stage IV), uninsured individuals (0·917 [0·875-0·961] for stage I; 1·102 [1·055-1·152] for stage IV), Medicare-insured adults younger than 65 years (0·909 [0·882-0·937] for stage I; 1·105 [1·068-1·144] for stage IV), and individuals living in the most socioeconomically deprived areas (0·931 [0·917-0·946] for stage I; 1·106 [1·087-1·125] for stage IV).

INTERPRETATION

Substantial cancer underdiagnosis and decreases in the proportion of early stage diagnoses occurred during 2020 in the USA, particularly among medically underserved individuals. Monitoring the long-term effects of the pandemic on morbidity, survival, and mortality is warranted.

FUNDING

None.

Cancer Disparities Experienced by People with Disabilities

People with disabilities, who represent a rapidly growing and seriously disadvantaged segment of the U.S. population, face unremitting barriers to equal and accessible healthcare and a high prevalence of chronic health conditions. A slowly growing body of research suggests multiple cancer-related disparities between people with and without disabilities. This commentary identifies multiple aspects of the cancer experience and highlights ways cancer is impacted by disability. This includes vulnerabilities to risk factors, barriers to accessing healthcare, and disparities in screening, diagnosis, and treatment. The authors offer six essential pathways for reducing cancer disparities faced by people with disabilities. It is clear that reducing cancer health disparities experienced by people with disabilities will require the commitment and cooperation of a wide range of stakeholders.