Effectiveness of screening for cervical cancer in an inpatient hospital setting

Serum Chloride and Admission Status Are Potential Prognostic Markers of High-Risk Polyps: A Prospective Characterization of Colorectal Polyps in a Tertiary Hospital in Saudi Arabia

Background: Colorectal cancer (CRC) is the most common cancer in men in Saudi Arabia. Other than age and family history, clinical and laboratory prognostic surrogates that may aid in streamlining and prioritization of screening colonoscopies are scarce. Through the examination of the local prevalence of advanced and malignant colorectal polyps, we hypothesized that the presence of certain clinical or laboratory parameters may signify an association with having high-risk polyps.

Methods: A prospective study over a period of one year starting on January 21, 2018 and involving all adult patients undergoing colonoscopy at King Saud Medical City, Riyadh. Of the total 1,104 recruited patients, 717 were included. The patients were sub-grouped based on the presence or absence of polyps. Patients with polyps were further sub-grouped into high-risk or low-risk polyps. Comparisons between groups were performed using univariate, relative risks (RRs), and multivariate analyses.

Results: Our polyp detection rate was 34.7% and our adenoma detection rate was 21.3%. The prevalence of advanced adenoma was 15.2% and the prevalence of malignant polyps was 6.7%. Several prognostic markers were associated with high-risk polyps such as advanced age (RR = 1.35, 95% confidence interval [CI]: 1.03 to 1.78), male gender (RR = 1.18, 95% CI: 1.06 to 1.31), inpatient status (RR = 1.46, 95% CI: 1.04 to 2.21), and low serum chloride (RR = 1.89, 95% CI: 1.05 to 2.37). With multivariate analysis, the hazard ratios for inpatient status and hypochloremia were 1.67 (95% CI: 1.034 to 2.612) and 1.12 (95% CI: 1.011 to 1.265), respectively.

Conclusion: We report the prevalence of malignant colorectal polyps in Saudi Arabia which was not reported before. Two unique prognostic markers for high-risk polyps were identified, namely, inpatient status and hypochloremia.

Hospitalized Women’s Perspective on Willingness-to-Screen for Cancers in Relation to Life Expectancy

Objective: Life expectancy is an important tool for physicians and patients to determine when medical services for disease prevention should be rendered. Since patients’ preference is an important predictor for cancer screening compliance, incorporating life expectancy with cancer screening preferences becomes essential. The purpose of the study is to explore the mean life expectancy duration that hospitalized women expect in order to undergo cancer screening tests.

Methods: A cross-sectional bedside survey including the contingent valuation method was used to assess the mean life expectancy among 475 cancer-free hospitalized women aged 50-75 years, which justified their willingness to undergo cancer screening tests. The probit and logistic regression models were used for the analysis in October 2021.

Results: A total of 74% of women were willing to undergo cancer screening if the mean life expectancy was 24.3 months (SE = 12.8, p = 0.058). After adjustment for sociodemographic and clinical covariates, hospitalized women were willing to undergo cancer screening if the mean life expectancy was 26.6 months (SE = 13.3, p = 0.045). Race (African American and others vs Caucasians, OR = 2.34, 95% CI: 1.43-3.81) and annual household income <$20,000 (OR = 1.71, 95% CI: 1.02-2.86) were associated with the willingness to undergo cancer screening among hospitalized women.

Conclusion: The study’s findings suggest that hospitalized women value the prospect of cancer screening tests, given the mean life expectancy of approximately 27 months. Therefore, offering screening tests to nonadherent hospitalized women with a mean life expectancy of 2¼ years, especially to those at high risk for developing cancer, with low income, or women of color, may improve adherence to cancer screening recommendations.

A Motivational Interviewing Intervention to Promote CRC Screening: A Pilot Study

BACKGROUND

Appalachian Kentuckians suffer a disproportionate incidence and mortality from colorectal cancer (CRC) and are screened at lower rates (35%) compared with 47% of Kentuckians.

OBJECTIVE

The aim of this study was to evaluate the efficacy of a motivational interviewing intervention delivered by trained Lay Health Advisors on CRC screening.

METHOD

Eligible participants recruited from an emergency department (ED) completed a baseline survey and were randomized to either the control or the motivational interviewing intervention provided by Lay Health Advisors. Follow-up surveys were administered 3 and 6 months after baseline. To evaluate potential differences in treatment and control groups, t tests, χ, and Mann-Whitney U tests were used.

RESULTS

At either the 3- or 6-month assessment, there was no difference in the CRC screening by group (χ = 0.13, P = .72). There was a significant main effect for the study group in the susceptibility to CRC model; regardless of time, those in the intervention group reported approximately 1-point higher perceived susceptibility to CRC, compared with controls (est. b = 0.68, P = .038). Age and financial adequacy had a significant effect related to CRC screening. Older participants (est. b = 0.09, P = .014) and those who reported financial inadequacy (est. b = 2.34, P = .002) reported more screening barriers.

CONCLUSION

This pilot study elucidated important factors influencing the uptake of CRC for an ED transient population and this may be useful in the design of future interventions using motivational interviewing in EDs.

IMPLICATIONS FOR PRACTICE

Nurses can provide information about CRC screening guidelines and provide referrals to appropriate screening resources in the community.

What do hospitalists think about inpatient mammography for hospitalized women who are overdue for their breast cancer screening?

BACKGROUND

A recent study showed that many hospitalized women are nonadherent with breast cancer screening recommendations, and that a majority of these women would be amenable to inpatient screening if it were offered.

OBJECTIVE

Explore hospitalists' views about the appropriateness of inpatient breast cancer screening and their concerns about related matters.

METHODS

A cross-sectional study was conducted among 4 hospitalist groups affiliated with Johns Hopkins Medical Institution. χ(2) and t-test statistics were used to identify hospitalist characteristics that were associated with being supportive of inpatient screening mammography.

RESULTS

The response rate was 92%. Sixty-two percent of respondents believed that hospitalists should not be involved in breast cancer screening. In response to clinical scenarios describing hospitalized women who were overdue for screening, only one-third of hospitalists said that they would order a screening mammogram. Lack of follow-up on screening mammography results was cited as the most common concern related to ordering the test.

CONCLUSIONS

Future studies are needed to evaluate the feasibility and potential barriers associated with inpatient screening mammography.

The influence of dermatologist and primary care physician visits on melanoma outcomes among Medicare beneficiaries

BACKGROUND

Ambulatory visits to dermatologists and primary care physicians (PCPs) may improve melanoma outcomes through early detection. We sought to measure the effect of dermatologist and PCP visits on melanoma stage at diagnosis and mortality.

METHODS

We used data from the database linking Surveillance Epidemiology and End Results (SEER) and Medicare data (1994 to 2005) to examine patterns of dermatologist and PCP ambulatory visits before diagnosis for 18,884 Medicare beneficiaries with invasive melanoma or unknown stage at diagnosis. Visits were assessed during the 2-year time interval before the month of diagnosis. We examined whether dermatologist and PCP visits were associated with diagnosis of thinner melanomas (defined as local stage tumors having Breslow thickness <1 mm) and lower melanoma mortality.

RESULTS

Medicare beneficiaries visiting both a dermatologist and PCP before diagnosis had greater odds of diagnosis of a thin melanoma (adjusted odds ratio, 1.26; 95% confidence interval, 1.12-1.41) and lower melanoma mortality (adjusted hazard ratio 0.66, 95% confidence interval, 0.57-0.76) compared with those without such visits. The mortality findings were attenuated once stage at diagnosis was adjusted for in the multivariable model.

CONCLUSION

Improved melanoma outcomes among Medicare beneficiaries may depend on adequate access and use of dermatologist and PCP services.

Improving survival disparities in cervical cancer between Māori and non-Māori women in New Zealand: a national retrospective cohort study

OBJECTIVE

Māori women in New Zealand have higher incidence of and mortality from cervical cancer than non-Māori women, however limited research has examined differences in treatment and survival between these groups. This study aims to determine if ethnic disparities in treatment and survival exist among a cohort of Māori and non-Māori women with cervical cancer.

METHODS

A retrospective cohort study of 1911 women (344 Māori and 1567 non-Māori) identified from the New Zealand Cancer Register with cervical cancer (adenocarcinoma, adenosquamous or squamous cell carcinoma) between 1 January 1996 and 31 December 2006.

RESULTS

Māori women with cervical cancer had a higher receipt of total hysterectomies, and similar receipt of radical hysterectomies and brachytherapy as primary treatment, compared to non-Māori women (age and stage adjusted). Over the cohort period, Māori women had poorer cancer specific survival than non-Māori women (mortality hazard ratio (HR) 2.07, 95% confidence interval (CI): 1.63-2.62). From 1996 to 2005, the survival for Māori improved significantly relative to non-Māori.

CONCLUSION

Māori continue to have higher incidence and mortality than non-Māori from cervical cancer although disparities are improving. Survival disparities are also improving. Treatment (as measured) by ethnicity is similar.

IMPLICATIONS

Primary prevention and early detection remain key interventions for addressing Māori needs and reducing inequalities in cervical cancer in New Zealand.

Influence of primary care on breast cancer outcomes among Medicare beneficiaries

PURPOSE

We used the Surveillance Epidemiology and End Results (SEER)-Medicare database to explore the association between primary care and breast cancer outcomes.

METHODS

Using a retrospective cohort study of 105,105 female Medicare beneficiaries with a diagnosis of breast cancer in SEER registries during the years 1994-2005, we examined the total number of office visits to primary care physicians and non-primary care physicians in a 24-month period before cancer diagnosis. For women with invasive cancers, we examined the odds of diagnosis of late-stage disease, according to the American Joint Commission on Cancer (AJCC) (stages III and IV vs stages I and II), and survival (breast cancer specific and all cause) using logistic regression and proportional hazards models, respectively. We also explored whether including noninvasive cancers, such as ductal carcinoma in situ (DCIS), would alter results and whether prior mammography was a potential mediator of associations.

RESULTS

Primary care physician visits were associated with improved breast cancer outcomes, including greater use of mammography, reduced odds of late-stage diagnosis, and lower breast cancer and overall mortality. Prior mammography (and resultant earlier stage diagnosis) mediated these associations in part, but not completely. Similar results were seen for non-primary care physician visits. Results were similar when women with DCIS were included in the analysis.

CONCLUSIONS

Medicare beneficiaries with breast cancer had better outcomes if they made greater use of a primary care physician's ambulatory services. These findings suggest adequate primary medical care may be an important factor in achieving optimal breast cancer outcomes.

Poor health, but not fracture and fall risk, is associated with nonattendance at bone mineral density screening

BACKGROUND

Bone mineral density screening identifies women at risk for fracture. Nonattendance at screening is associated with subsequent hip fracture. Determining reasons for nonattendance may help in the designing of methods to improve screening.

METHODS

We hypothesize that nonattenders may report poorer health and have a higher risk of fracture and fall. Women were randomly chosen from a list of people scheduled for a screening dual x-ray absorptiometry (DXA) scan. We used a validated telephone survey to calculate osteoporosis, fracture, and fall risk scores. Women answered questions about their health and medical conditions.

RESULTS

Of 263 women contacted, 226 (86%) women agreed to participate; 145 participants completed a dual-energy x-ray absorptiometry scan and 81 women failed to attend. Women who did not attend screening were more likely to report a serious medical condition (59.3% vs 46.9%; P = 0.09). Nonattenders were more likely to report their health as fair or poor (51.9% vs 33.8%; P = 0.01). There were no differences for osteoporosis, fall, and fracture risks.

CONCLUSIONS

Failure to attend osteoporosis screening is associated with significant health problems and poor self-rated health. Improving point of care access may increase the amount of osteoporosis screening among women with multiple comorbidities.

A captive audience: a pilot study of screening and counseling hospitalized women for fracture risk

BACKGROUND

Innovative methods are needed to improve screening for osteoporosis, especially in women with multiple comorbid conditions.

OBJECTIVES

Determine whether a fracture risk-screening program including a bedside calcaneal ultrasound is feasible in hospitalized women, and determine whether identification of fracture risks results in behavior change after discharge.

DESIGN

Prospective uncontrolled feasibility study.

SETTING

Five hundred twenty-eight bed academic hospital.

PARTICIPANTS

One hundred three hospitalized women age 60 years or older.

METHODS

A bedside calcaneal ultrasound was used to estimate bone mineral density. Clinical fracture risks were obtained via interview. The patient and primary care physician received personalized risk information and educational material.

RESULTS

Of 103 eligible women, 59 (57%) agreed to undergo bedside screening and counseling. Of these 59 women, 49 (83%) had at least one major clinical risk factor for fracture. The median T-score was -2.5. Among the 42 women available for phone follow-up 2 months after hospital discharge, 34 (81%) reported after at least 1 recommendation to diminish fracture risk.

CONCLUSION

A hospital-based osteoporosis screening program using calcaneal ultrasound is feasible and identifies women at risk of fracture. Feedback of low bone mineral density and fracture risk during hospitalization may promote behavior change to diminish fracture risk after discharge.