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Jones O, Young H, Clarke H, Crosbie EJ, Sivalingam VN. The Womb Cancer Awareness Measure (WCAM): development of an instrument to assess public awareness of endometrial cancer. Int J Gynecol Cancer 2023; 34:ijgc-2023-004796. [PMID: 38088173 PMCID: PMC10850626 DOI: 10.1136/ijgc-2023-004796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To develop and test a novel instrument to assess public awareness of endometrial cancer symptoms and risk factors in a UK population. METHODS A 36-item questionnaire was developed through literature review and extraction from cancer awareness materials. The Womb Cancer Awareness Measure (WCAM) was tested for content validity in 65 self-identified female research participants and 10 endometrial cancer experts prior to UK-wide field testing using social media. Test-retest reliability was assessed over 2 weeks, construct validity was assessed by comparing womb cancer experts and non-medical academics, and sensitivity to change was assessed by comparing scores of participants who read an endometrial cancer leaflet with those given a control leaflet. RESULTS Fifty-two percent of the items in the test-retest reliability showed >80% agreement. Construct validity was demonstrated; endometrial cancer experts achieved higher scores (median 79 (IQR 18)) than non-medical academics (median 50 (IQR 18)) (p<0.001). The WCAM was sensitive to change; volunteers who read an endometrial cancer leaflet showed greater awareness (median 73 (IQR 9)) than those who read the control leaflet (median 59 (IQR 9)) (p<0.001). Knowledge of endometrial cancer red flag symptoms and risk factors was poor in the 847 UK-based participants. CONCLUSIONS Our findings support the validity and reliability of the Womb Cancer Awareness Measure in assessing public awareness of endometrial cancer. In a UK population sample, knowledge of warning symptoms and risk factors was low, highlighting the need for public awareness campaigns.
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Affiliation(s)
- Olivia Jones
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Hannah Young
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Helen Clarke
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Emma J Crosbie
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Department of Colposcopy and Gynaecological Oncology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vanitha N Sivalingam
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Gynaecology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
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Shaw B, Walter FM, Hamilton W, Martins T. Symptom appraisal and help seeking in males with symptoms of possible prostate cancer: a qualitative study with an ethnically diverse sample in London. Br J Gen Pract 2023; 73:e502-e510. [PMID: 37253629 PMCID: PMC10242866 DOI: 10.3399/bjgp.2022.0554] [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: 11/06/2022] [Revised: 12/07/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Prostate cancer mortality in Black males is disproportionately high. This problem may be overcome by reducing delays in the pathway to diagnosis, particularly those occurring before initial medical help seeking. A greater understanding of symptom appraisal and help seeking could support the development of targeted interventions for improving early presentation among Black males. AIM To provide an in-depth understanding of males' pre-consultation experiences following the onset of symptoms of possible prostate cancer, identifying both general trends as well as potential differences that may exist between Black and White males. DESIGN AND SETTING Qualitative study of 18 males (nine Black, nine White) in London, UK, who had recently seen their GP with urinary symptoms, erectile dysfunction, or haematuria. METHOD Semi-structured interviews from a previous multi-methods study of primary care use by males with symptoms of possible prostate cancer were analysed using thematic framework analysis. RESULTS Symptoms were often interpreted by patients as unimportant. Most delays occurred due to the absence of reasons to seek help, which, in Black males, often stemmed from poor awareness of prostate cancer. This lack of awareness could have been a consequence of their reluctance to seek health information and discuss health issues with others in their social network. Friends and relatives played an important role in symptom appraisal and help seeking. CONCLUSION Cognitive biases, cultural stigmas, and everyday interpersonal interactions should be important areas at which to target strategies seeking to reduce delays and improve early presentation in males with possible prostate cancer, particularly Black males.
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Affiliation(s)
- Ben Shaw
- College of Medicine and Health, University of Exeter, Exeter
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
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Kourouni I, Suguness A, Finley J, Josan ES, Dutton K, Tarabichi Y. Reducing Racial Disparities in the Timeliness of Potential Lung Cancer Evaluation With a Novel Application-Supported Rapid Outpatient Diagnostic Program: An Interrupted Time Series Analysis. Clin Lung Cancer 2023; 24:339-346. [PMID: 37002154 PMCID: PMC10225315 DOI: 10.1016/j.cllc.2023.02.008] [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: 10/16/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Rapid outpatient diagnostic programs (RODP) expedite lung cancer evaluation, but their impact on racial disparities in the timeliness of evaluation is less clear. MATERIALS AND METHODS This was a retrospective analysis of the impact of an internally developed application-supported RODP on racial disparities in timely referral completion rates for patients with potential lung cancer at a safety-net healthcare system. An application screened referrals to pulmonology for indications of lung mass or nodule and presented relevant clinical information that enabled dedicated pulmonologists to efficiently review and triage cases according to urgency. Subsequent care coordination was overseen by a dedicated nurse coordinator. To determine the program's impact, we conducted an interrupted time series analysis of the monthly fraction of referrals completed within 30 days, stratified by those identified as White, non-Hispanic and those that were not (racial and ethnic minorities). RESULTS There were 902 patients referred in the 2 years preintervention and 913 in the 2 years postintervention. Overall, the median age was 63 years, and 44.7% of referred patients were female. 44.2% were White, non-Hispanic while racial and ethnic minorities constituted 54.3%. After the intervention, there was a significant improvement in the proportion of referrals completed within 30 days (62.4% vs. 48.2%, P <.01). The interrupted time series revealed a significant immediate improvement in timely completion among racial and ethnic minorities (23%, P < .01) that was not reflected in the majority White, non-Hispanic subgroup (11%, not significant). CONCLUSION A thoughtfully designed and implemented RODP reduced racial disparities in the timely evaluation of potential lung cancer.
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Affiliation(s)
- Ismini Kourouni
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Arvind Suguness
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH; Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH
| | - James Finley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Katherine Dutton
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH
| | - Yasir Tarabichi
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH; Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH.
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Richardson-Parry A, Baas C, Donde S, Ferraiolo B, Karmo M, Maravic Z, Münter L, Ricci-Cabello I, Silva M, Tinianov S, Valderas JM, Woodruff S, van Vugt J. Interventions to reduce cancer screening inequities: the perspective and role of patients, advocacy groups, and empowerment organizations. Int J Equity Health 2023; 22:19. [PMID: 36707816 PMCID: PMC9880917 DOI: 10.1186/s12939-023-01841-6] [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: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Health inequities lead to low rates of cancer screening in certain populations, such as low-income and ethnic minority groups. Different interventions to address this have been developed with mixed results. However, interventions are not always developed in collaboration with the people they target. The aim of our article is to present the viewpoint of patients, survivors, advocates, and lay persons on interventions to increase cancer screening from a health inequity perspective. METHODS We prepared talking points to guide discussions between coauthors, who included representatives from nine patient and survivor advocacy groups, organizations working for citizen/patient empowerment, and health equity experts. Perspectives and opinions were first collected through video conferencing meetings and a first draft of the paper was prepared. All authors, read through, revised, and discussed the contents to reach an agreement on the final perspectives to be presented. RESULTS Several themes were identified: it is important to not view screening as a discrete event; barriers underlying an individual's access and willingness to undergo screening span across a continuum; individually tailored interventions are likely to be more effective than a one-size fits-all approach because they may better accommodate the person's personal beliefs, knowledge, behaviors, and preferences; targeting people who are unknown to medical services and largely unreachable is a major challenge; including professional patient advocacy groups and relevant lay persons in the cocreation of interventions at all stages of design, implementation, and evaluation is essential along with relevant stakeholders (healthcare professionals, researchers, local government and community organizations etc). CONCLUSIONS Interventions to address cancer screening inequity currently do not adequately solve the issue, especially from the viewpoint of patients, survivors, and lay persons. Several core pathways should be focused on when designing and implementing interventions: advancing individually tailored interventions; digital tools and social media; peer-based approaches; empowerment; addressing policy and system barriers; better design of interventions; and collaboration, including the involvement of patients and patient advocacy organizations.
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Affiliation(s)
- Afua Richardson-Parry
- Viatris Global Healthcare UK, Building 4, Trident Place, Mosquito Way, Hatfield, London, AL10 9UL UK
| | - Carole Baas
- grid.470316.7Alamo Breast Cancer Foundation, 909 Midland Creek Drive, Southlake, TX 76092 USA
| | - Shaantanu Donde
- Viatris Global Healthcare, Building 4, Trident Place, Mosquito Way, Hatfield, London, AL10 9UL UK
| | - Bianca Ferraiolo
- Cittadinanzattiva - Active Citizenship Network, Rue Philippe Le Bon 46, 1000 Brussels, Belgium
| | - Maimah Karmo
- grid.430731.2Tigerlily Foundation, 42020 Village Center Plaza, #120-156, Stone Ridge, 20105 USA
| | - Zorana Maravic
- Digestive Cancers Europe, Rue de la Loi 235/27, 1040 Brussels, Belgium
| | - Lars Münter
- Danish Committee for Health Education, Classensgade 71, 5, 2100 Copenhagen, Denmark
| | - Ignacio Ricci-Cabello
- grid.507085.fBalearic Islands Health Research Institute (IdISBa) and CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Escola Graduada 3, 07002 Palma, Balearic Islands Spain
| | - Mitchell Silva
- Esperity, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Stacey Tinianov
- Advocates for Collaborative Education, 824 Windsor Street, Santa Cruz, CA 95062 USA
| | - Jose M. Valderas
- grid.4280.e0000 0001 2180 6431National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228 Singapore
| | | | - Joris van Vugt
- Viatris, Aalsterweg 172, 5644 RH Eindhoven, The Netherlands
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Briggs E, de Kamps M, Hamilton W, Johnson O, McInerney CD, Neal RD. Machine Learning for Risk Prediction of Oesophago-Gastric Cancer in Primary Care: Comparison with Existing Risk-Assessment Tools. Cancers (Basel) 2022; 14:cancers14205023. [PMID: 36291807 PMCID: PMC9600097 DOI: 10.3390/cancers14205023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Oesophago-gastric cancer is one of the commonest cancers worldwide, yet it can be particularly difficult to diagnose given that initial symptoms are often non-specific and routine screening is not available. Cancer risk-assessment tools, which calculate cancer risk based on symptoms and other risk factors present in the primary care record, can aid decisions on referrals for cancer investigations, facilitating earlier diagnosis. Diagnosing common cancers earlier could help improve survival rates. Using UK primary care electronic health record data, we compared five different machine learning techniques for probabilistic classification of cancer patients against a current widely used UK primary care cancer risk-assessment tool. The machine learning algorithms outperformed the current risk-assessment tool, with a higher overall accuracy and an ability to reasonably identify 11–25% more cancer patients. We conclude that machine-learning-based risk-assessment tools could help better identify suitable patients for further investigation and support earlier diagnosis. Abstract Oesophago-gastric cancer is difficult to diagnose in the early stages given its typical non-specific initial manifestation. We hypothesise that machine learning can improve upon the diagnostic performance of current primary care risk-assessment tools by using advanced analytical techniques to exploit the wealth of evidence available in the electronic health record. We used a primary care electronic health record dataset derived from the UK General Practice Research Database (7471 cases; 32,877 controls) and developed five probabilistic machine learning classifiers: Support Vector Machine, Random Forest, Logistic Regression, Naïve Bayes, and Extreme Gradient Boosted Decision Trees. Features included basic demographics, symptoms, and lab test results. The Logistic Regression, Support Vector Machine, and Extreme Gradient Boosted Decision Tree models achieved the highest performance in terms of accuracy and AUROC (0.89 accuracy, 0.87 AUROC), outperforming a current UK oesophago-gastric cancer risk-assessment tool (ogRAT). Machine learning also identified more cancer patients than the ogRAT: 11.0% more with little to no effect on false positives, or up to 25.0% more with a slight increase in false positives (for Logistic Regression, results threshold-dependent). Feature contribution estimates and individual prediction explanations indicated clinical relevance. We conclude that machine learning could improve primary care cancer risk-assessment tools, potentially helping clinicians to identify additional cancer cases earlier. This could, in turn, improve survival outcomes.
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Affiliation(s)
- Emma Briggs
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Correspondence:
| | - Marc de Kamps
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9NL, UK
- The Alan Turing Institute, London NW1 2DB, UK
| | - Willie Hamilton
- Department of Health and Community Sciences, University of Exeter, Exeter EX1 2LU, UK
| | - Owen Johnson
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9NL, UK
| | - Ciarán D. McInerney
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield S10 2TN, UK
| | - Richard D. Neal
- Department of Health and Community Sciences, University of Exeter, Exeter EX1 2LU, UK
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Martins T, Abel G, Ukoumunne OC, Price S, Lyratzopoulos G, Chinegwundoh F, Hamilton W. Assessing Ethnic Inequalities in Diagnostic Interval of Common Cancers: A Population-Based UK Cohort Study. Cancers (Basel) 2022; 14:3085. [PMID: 35804858 PMCID: PMC9264889 DOI: 10.3390/cancers14133085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study investigated ethnic differences in diagnostic interval (DI)-the period between initial primary care presentation and diagnosis. METHODS We analysed the primary care-linked data of patients who reported features of seven cancers (breast, lung, prostate, colorectal, oesophagogastric, myeloma, and ovarian) one year before diagnosis. Accelerated failure time (AFT) models investigated the association between DI and ethnicity, adjusting for age, sex, deprivation, and morbidity. RESULTS Of 126,627 eligible participants, 92.1% were White, 1.99% Black, 1.71% Asian, 1.83% Mixed, and 2.36% were of Other ethnic backgrounds. Considering all cancer sites combined, the median (interquartile range) DI was 55 (20-175) days, longest in lung [127, (42-265) days], and shortest in breast cancer [13 (13, 8-18) days]. DI for the Black and Asian groups was 10% (AFT ratio, 95%CI 1.10, 1.05-1.14) and 16% (1.16, 1.10-1.22), respectively, longer than for the White group. Site-specific analyses revealed evidence of longer DI in Asian and Black patients with prostate, colorectal, and oesophagogastric cancer, plus Black patients with breast cancer and myeloma, and the Mixed group with lung cancer compared with White patients. DI was shorter for the Other group with lung, prostate, myeloma, and oesophagogastric cancer than the White group. CONCLUSION We found limited and inconsistent evidence of ethnic differences in DI among patients who reported cancer features in primary care before diagnosis. Our findings suggest that inequalities in diagnostic intervals, where present, are unlikely to be the sole explanation for ethnic variations in cancer outcomes.
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Affiliation(s)
- Tanimola Martins
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
| | - Gary Abel
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter EX1 2LU, UK; (G.A.); (O.C.U.)
| | - Obioha C. Ukoumunne
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter EX1 2LU, UK; (G.A.); (O.C.U.)
| | - Sarah Price
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1–19 Torrington Place, London WC1E 7HB, UK;
| | - Frank Chinegwundoh
- Barts Health NHS Trust & Department of Health Sciences, University of London, London WC1E 7HB, UK;
| | - William Hamilton
- College House St Luke’s Campus, College of Medicine and Health, University of Exeter, Magdalen Road, Exeter EX1 2LU, UK; (S.P.); (W.H.)
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Delon C, Brown KF, Payne NWS, Kotrotsios Y, Vernon S, Shelton J. Differences in cancer incidence by broad ethnic group in England, 2013-2017. Br J Cancer 2022; 126:1765-1773. [PMID: 35233092 PMCID: PMC9174248 DOI: 10.1038/s41416-022-01718-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cancer incidence variation between population groups can inform public health and cancer services. Previous studies have shown cancer incidence rates vary by ethnic group in England. Since their publication, the completeness of ethnicity recording in cancer data has improved, and relevant inequalities (e.g. risk factor prevalence and healthcare access) may have changed. METHODS Age-standardised incidence rates were calculated for Asian, Black, Mixed/Multiple and White ethnic groups in England in 2013-2017, using almost 3 million diagnoses across 31 cancer sites. Rate ratios were calculated with the White ethnic group as reference. Sensitivity analyses used imputed ethnicity for cases with missing data and perturbed population estimates. RESULTS Incidence rates for most cancer sites and ethnic group and sex combinations were lower in non-White minority ethnic groups compared with the corresponding White group, with particularly low rate ratios (below 0.5) for melanoma skin cancer and some smoking-related cancers (lung, bladder and oesophageal cancers). Exceptions included prostate cancer (2.1 times higher in males of Black ethnicity), myeloma (2.7-3.0 times higher in people of Black ethnicity), several gastrointestinal cancers (1.1-1.9 times higher in people of Black ethnicity, 1.4-2.2 times higher in people of Asian ethnicity), Hodgkin lymphoma (1.1 times higher in males of Asian ethnicity, 1.3 times higher in males of Black ethnicity) and thyroid cancers (1.4 times higher in people of Asian ethnicity, 1.2 times higher in people of Black ethnicity). Sensitivity analyses did not materially alter these results (rate ratios changed by a maximum of 12 percentage points, the direction and significance of results were unchanged in all but two cancer site/sex/ethnic group combinations). CONCLUSIONS People of non-White minority ethnicity in England generally have lower cancer risk than the White population, though there are a number of notable exceptions. These results should galvanise efforts to better understand the reasons for this variation, and the possible impact on cancer services, patient experiences and outcomes.
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Affiliation(s)
- Christine Delon
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK.
| | - Katrina F Brown
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Nick W S Payne
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Yannis Kotrotsios
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Sally Vernon
- National Disease Registration Service, NHS Digital, 7 and 8 Wellington Place, Leeds, LS1 4AP, UK
| | - Jon Shelton
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
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Associations between multiple long-term conditions and mortality in diverse ethnic groups. PLoS One 2022; 17:e0266418. [PMID: 35363804 PMCID: PMC8974956 DOI: 10.1371/journal.pone.0266418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. Methods and findings A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Long-term conditions were counted from a list of 32 that have previously been associated with greater primary care, hospital admissions, or mortality risk. Cox regression models were used to estimate mortality by count of conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional condition at baseline was associated with increased mortality. The direction of the interaction of number of conditions with ethnicity showed a statistically higher mortality rate associated with long-term conditions in Pakistani, Black African, Black Caribbean and Other Black ethnic groups. In ethnicity-stratified models, the mortality rate per additional condition at age 50 was 1.33 (95% CI 1.31,1.35) for White ethnicity, 1.43 (95% CI 1.26,1.61) for Black Caribbean ethnicity and 1.78 (95% CI 1.41,2.24) for Other Black ethnicity. Conclusions The higher mortality rate associated with having multiple conditions is greater in minoritised compared with White ethnic groups. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.
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Tyrer F, Bhaskaran K, Rutherford MJ. Immortal time bias for life-long conditions in retrospective observational studies using electronic health records. BMC Med Res Methodol 2022; 22:86. [PMID: 35350993 PMCID: PMC8962148 DOI: 10.1186/s12874-022-01581-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/17/2022] [Indexed: 01/10/2023] Open
Abstract
Background Immortal time bias is common in observational studies but is typically described for pharmacoepidemiology studies where there is a delay between cohort entry and treatment initiation. Methods This study used the Clinical Practice Research Datalink (CPRD) and linked national mortality data in England from 2000 to 2019 to investigate immortal time bias for a specific life-long condition, intellectual disability. Life expectancy (Chiang’s abridged life table approach) was compared for 33,867 exposed and 980,586 unexposed individuals aged 10+ years using five methods: (1) treating immortal time as observation time; (2) excluding time before date of first exposure diagnosis; (3) matching cohort entry to first exposure diagnosis; (4) excluding time before proxy date of inputting first exposure diagnosis (by the physician); and (5) treating exposure as a time-dependent measure. Results When not considered in the design or analysis (Method 1), immortal time bias led to disproportionately high life expectancy for the exposed population during the first calendar period (additional years expected to live: 2000–2004: 65.6 [95% CI: 63.6,67.6]) compared to the later calendar periods (2005–2009: 59.9 [58.8,60.9]; 2010–2014: 58.0 [57.1,58.9]; 2015–2019: 58.2 [56.8,59.7]). Date of entry of diagnosis (Method 4) was unreliable in this CPRD cohort. The final methods (Method 2, 3 and 5) appeared to solve the main theoretical problem but residual bias may have remained. Conclusions We conclude that immortal time bias is a significant issue for studies of life-long conditions that use electronic health record data and requires careful consideration of how clinical diagnoses are entered onto electronic health record systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01581-1.
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Affiliation(s)
- Freya Tyrer
- Department of Health Sciences (Biostatistics Research Group), University of Leicester, Leicester, UK.
| | - Krishnan Bhaskaran
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark J Rutherford
- Department of Health Sciences (Biostatistics Research Group), University of Leicester, Leicester, UK
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Mohd Mujar NM, Dahlui M, Emran NA, Hadi IA, Yan YW, Arulanantham S, Chea CH, Mohd Taib NA. Breast Cancer Care Timeliness Framework: A Quality Framework for Cancer Control. JCO Glob Oncol 2022; 8:e2100250. [PMID: 35286134 PMCID: PMC8932493 DOI: 10.1200/go.21.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study is to determine the pathway that women follow for Breast Cancer Care (BCC) and the time intervals from symptom discovery to treatment initiation and to develop a quality matrix framework. METHODS A retrospective cohort study was conducted at six tertiary centers in Malaysia. All women with newly diagnosed breast cancer were interviewed, and a medical records review was conducted using a structured questionnaire. The BCC timeliness framework showed that the total time between a woman discovering their first breast changes and the date of initial treatment was divided into three distinct intervals: presentation interval, diagnostic interval, and treatment interval. Four diagnosis subintervals, referral, biopsy, report, and diagnosis resolution intervals, were also looked into. RESULTS The BCC timeliness framework was used to capture important time points. The median total time, presentation interval, diagnostic interval, and treatment interval were 4.9 months (range, 1 month to 10 years), 2.4 months (range, 7 days to 10 years), 26 days (range, 4 days to 9.3 months), and 21 days (range, 1 day to 7.2 months), respectively. Meanwhile, the median time for the diagnosis subinterval of referral, biopsy, report, and diagnosis resolution was 8 days (range, 0 day to 8 months), 0 day (range, 0 day to 20 days), 7 days (range, 3 days to 3.5 months), and 4 days (range, 1 day to 1.8 months), respectively. CONCLUSION The BCC timeliness framework is based on the current sequenced trajectory of the BCC journey. Clarity in the measurement of timeliness provides a standardized language for monitoring and outcome research. It can serve as a quality indicator for community and hospital-based breast cancer programs.
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Affiliation(s)
- Noor Mastura Mohd Mujar
- Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, UM Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Malaysia
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Prevalence of Overactive Bladder Symptoms Among Women With Interstitial Cystitis/Bladder Pain Syndrome. Female Pelvic Med Reconstr Surg 2022; 28:e115-e119. [PMID: 35272344 PMCID: PMC8928040 DOI: 10.1097/spv.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Symptoms of urinary frequency, urgency, and urinary leakage are characteristic of overactive bladder (OAB) syndrome. However, frequency and urgency symptoms are also present in most patients with interstitial cystitis/bladder pain syndrome (IC/BPS). OBJECTIVE Our objective was to describe the urge incontinence among women with IC/BPS, which may indicate true overlap of OAB and IC/BPS. STUDY DESIGN This is a prospective study of women with IC/BPS diagnosed clinically in the Veterans Affairs Health Care system. Patients completed the OAB and Female Genitourinary Pain Index (F-GUPI) questionnaires. Questions from the OAB questionnaire were used to analyze symptoms of urinary urgency and urge incontinence. Pain symptoms, urinary symptoms, and impact on quality of life were assessed based on the F-GUPI. Patient demographics, comorbidities, and symptoms were reviewed. RESULTS Within the cohort of 144 women with IC/BPS, 100 (69%) had urinary leakage associated with the strong desire to void and were more likely to have incontinence compared with healthy controls (P < 0.001). The IC/BPS group also had higher total and pain scores on the F-GUPI (P < 0.001), but pain scores were not affected by the presence of incontinence (P = 0.478). CONCLUSIONS The prevalence of OAB symptoms of urinary leakage is high among women with IC/BPS. This may explain the efficacy of OAB medication and third-line therapies in this population.
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Zhang J, Oberoi J, Karnchanachari N, IJzerman MJ, Bergin RJ, Druce P, Franchini F, Emery JD. A systematic overview on risk factors and effective interventions to reduce time to diagnosis and treatment in lung cancer. Lung Cancer 2022; 166:27-39. [DOI: 10.1016/j.lungcan.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
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Kuehnle E, Siggelkow W, Luebbe K, Schrader I, Noeding KH, Noeding S, Noesselt T, Hillemanns P, Dörk T, Park-Simon TW. First Prospective Cross-Sectional Study on the Impact of Immigration Background and Education in Early Detection of Breast Cancer. Breast Care (Basel) 2021; 16:516-522. [PMID: 34720811 DOI: 10.1159/000511654] [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: 07/17/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Although immigrant health is an important issue in national health policy, there is a serious shortage of data in many countries. Most studies lack information on educational status, which is a major limitation. This prospective cross-sectional study analyzed a real-world breast cancer population on the influence of immigration background and educational status on participation in breast cancer early detection programs in the federal state of Lower Saxony, Germany. Methods Data collection was conducted from 2012 to 2016 in six certified breast cancer centers using a standardized questionnaire for patients' interview and tumor-specific data from the patients' medical records. Results 2,145/3,047 primary breast cancer cases were analyzed. 17.5% of our patients had a history of immigration, including n = 202 first-generation immigrants and n = 168 second-generation immigrants. Most of them were citizens of EU27 member states. No significant difference was seen in age, tumor stage, histology, grading, Ki-67, Her2/neu-status, and hormone receptor status compared to the native cohort. 100% participation rate in the breast cancer early detection programs were seen in patients with no school graduation. With regards to the national mammography screening program, participation decreased significantly with educational status (p = 0.0003). Conclusions No tumor biological differences were seen between immigrants and German natives. In first-generation immigrants, early detection programs were well accepted despite sociocultural and language differences. Participation rate decreased significantly with higher education levels irrespective of country of origin. Immigration background does not have a negative effect on the participation in breast cancer screening. This mainly relates to immigrants from EU27 member states.
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Affiliation(s)
- Elna Kuehnle
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Wulf Siggelkow
- DIAKOVERE Henriettenstift, Breast Center, Hannover, Germany
| | | | - Iris Schrader
- DIAKOVERE Henriettenstift, Breast Center, Hannover, Germany
| | | | | | | | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
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Martins T, Walter FM, Penfold C, Abel G, Hamilton W. Primary care use by men with symptoms of possible prostate cancer: A multi-method study with an ethnically diverse sample in London. Eur J Cancer Care (Engl) 2021; 30:e13482. [PMID: 34152656 DOI: 10.1111/ecc.13482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/15/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to investigate primary care use by men with recent onset of lower urinary tract symptoms (LUTS) to identify differences in presentation and investigation that may explain ethnic inequality in prostate cancer outcomes. METHODS This is a multi-method study of men presenting LUTS to primary care. Two hundred seventy-four men completed a self-administered questionnaire, and 23 participated in face-to-face interviews. Regression analyses investigated ethnic differences in (a) the period between symptom onset and first primary care presentation (patient interval) and (b) the interval between first primary care presentation and investigation with prostate-specific antigen (PSA) and digital rectal examination (DRE). Interview data were analysed using thematic analysis. RESULTS Half (144, 53%) reported a solitary first symptom, although multiple first symptoms were also common, particularly in Asian and Black men. There was no difference between ethnicities in patient interval or time from presentation to investigation. However, Asian men were offered less PSA testing (odds ratio 0.39; 95% confidence interval 0.17-0.92; p = 0.03). Qualitative data revealed ethnic differences in general practitioners' offer of DRE and PSA testing and highlighted limitations in doctor-patient communication and safety netting. CONCLUSION Our study showed only small differences in primary care experiences, insufficient to explain ethnic inequalities in prostate cancer outcomes.
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Affiliation(s)
- Tanimola Martins
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Clarissa Penfold
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute of Palliative Care, London, UK
| | - Gary Abel
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
| | - William Hamilton
- College of Medicine and Health, University of Exeter-College House St Luke's Campus, Exeter, UK
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Abstract
OBJECTIVE The aim of the study was to investigate the association between sense of coherence (SOC) and all-cause mortality in the general adult population. METHODS We conducted a systematic review and meta-analysis of prospective cohort studies. We searched eight electronic bibliographic databases for eligible studies. A random effects model and the restricted maximum likelihood method were used to calculate the pooled effect size. RESULTS Eight studies were eligible for the meta-analysis. The studies included 48,138 participants, of whom 5307 died during a median follow-up of 14.1 years (range, 8-29.5 years). Their age ranged from 20 to 80 years, and 53% of them were men. In the meta-analysis model of crude values, the risk of all-cause mortality for individuals with a weak SOC (lowest tertile) was 1.30 (95% confidence interval [CI] = 1.09-1.55, p = .003, I = 78.84%) compared with individuals with a strong SOC (highest tertile). In the model adjusted for age, the risk remained almost the same (risk ratio = 1.26, 95% CI = 1.15-1.38, p < .001, I = 69.59%). In the model adjusted for several other risk factors for mortality, the risk was still 1.17 (95% CI = 1.07-1.27, p < .001, I = 57.85%). CONCLUSIONS This meta-analysis shows that a weak SOC is associated with an increased risk of all-cause mortality in the general adult population. Future studies are needed to further develop assessment tools for SOC with good psychometric properties and to determine the disease processes that mediate the association of SOC with mortality.
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Matthew OJ, Eludoyin AO, Oluwadiya KS. Spatio-temporal variations in COVID-19 in relation to the global climate distribution and fluctuations. Spat Spatiotemporal Epidemiol 2021; 37:100417. [PMID: 33980401 PMCID: PMC7973081 DOI: 10.1016/j.sste.2021.100417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/11/2020] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
This study investigated the spatio-temporal variations in the occurrence of COVID-19 (confirmed cases and deaths) in relation to climate fluctuations in 61 countries, scattered around the world, from December 31, 2019 to May 28, 2020. Logarithm transformation of the count variable (COVID-19 cases) was used in a multiple linear regression model to predict the potential effects of weather variables on the prevalence of the disease. The study revealed strong associations (-0.510 ≤ r ≤ -0.967; 0.519 ≤ r ≤ 0.999) between climatic variables and confirmed cases of COVID-19 in majority (68.85%) of the selected countries. It showed evidences of 1 to 7-day delays in the response of the infection to changes in weather pattern. Model simulations suggested that a unit fall in temperature and humidity could increase (0.04-18.70%) the infection in 19.67% and 16.39% of the countries, respectively, while a general reduction (-0.05 to 9.40%) in infection cases was projected in 14.75% countries with a unit drop in precipitation. In conclusion, the study suggests that effective public health interventions are crucial to containing the projected upsurge in COVID-19 cases during both cold and warm seasons in the southern and northern hemispheres.
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Thøgersen H, Møller B, Åsli LM, Bhargava S, Kvåle R, Fjellbirkeland L, Robsahm TE, Aaserud S, Babigumira R, Larsen IK. Waiting times and treatment following cancer diagnosis: comparison between immigrants and the Norwegian host population. Acta Oncol 2020; 59:376-383. [PMID: 31920119 DOI: 10.1080/0284186x.2019.1711167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: There are concerns about timely access to appropriate cancer treatment for the growing immigrant population in Norway. This study aims to compare waiting times between cancer diagnosis and start of cancer treatment, as well as treatment patterns between immigrants in Norway and the host population.Material and methods: We performed a nationwide, registry-based study with individual-level data, including 213,320 Norwegians and 8324 immigrants diagnosed with breast, colorectal, lung or prostate cancer in 1990-2014. Differences in time from diagnosis to treatment and in treatment patterns were described for the selected cancer sites. The Cox and logistic regressions were used to adjust for patient and tumour characteristics.Results: After adjustment for covariates, hazard ratios for time from diagnosis to treatment for non-Western immigrants compared to Norwegians were 0.88 (95% confidence interval (CI): 0.82-0.95) for breast cancer and 0.84 (95% CI: 0.75-0.95) for lung cancer, indicating longer waiting times. Treatment patterns in the four major cancer sites were similar among immigrants and the Norwegian host population, except for breast cancer, where women from East and South Asia received less breast-conserving surgery than the Norwegian host population (adjusted odds ratios 0.65 (95% CI: 0.46-0.93) for East Asians and 0.75 (95% CI: 0.50-1.13) for South Asians).Conclusions: The present study reports delayed treatment for lung and breast cancer among immigrants from non-Western countries in Norway. Systematic differences in cancer treatment were not detected. However, less breast-conserving surgery among breast cancer patients from Asia compared to Norwegians was observed.
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Affiliation(s)
- Håvard Thøgersen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Basic Medical Sciences, Oslo, Norway
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Linn Merete Åsli
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Sameer Bhargava
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Rune Kvåle
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Division for Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
| | - Lars Fjellbirkeland
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Stein Aaserud
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Ronnie Babigumira
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Inger Kristin Larsen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
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Henriksson R. It is not just about molecules! Optimal cancer care for the future needs more research on external factors. Acta Oncol 2020; 59:373-375. [PMID: 32048539 DOI: 10.1080/0284186x.2020.1726458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Roger Henriksson
- Department of Radiation Sciences, University of Umea, Umea, Sweden
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Tapia KA, Garvey G, McEntee MF, Rickard M, Lydiard L, Brennan PC. Breast screening attendance of Aboriginal and Torres Strait Islander women in the Northern Territory of Australia. Aust N Z J Public Health 2019; 43:334-339. [PMID: 31268228 DOI: 10.1111/1753-6405.12917] [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: 12/01/2018] [Revised: 04/01/2019] [Accepted: 05/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare breast screening attendances of Indigenous and non-Indigenous women. METHODS A total of 4,093 BreastScreen cases were used including 857 self-identified Indigenous women. Chi-squared analysis compared data between Indigenous and non-Indigenous women. Logistic regression was used for groupings based on visits-to-screening frequency. Odds ratios and 95% confidence intervals were calculated for associations with low attendance. RESULTS Indigenous women were younger and had fewer visits to screening compared with non-Indigenous women. Non-English speaking was mainly associated with fewer visits for Indigenous women only (OR 1.9, 95%CI 1.3-2.9). Living remotely was associated with fewer visits for non-Indigenous women only (OR 1.3, 95%CI 1.1-1.5). Shared predictors were younger age (OR 12.3, 95%CI 8.1-18.8; and OR 11.5, 95%CI 9.6-13.7, respectively) and having no family history of breast cancer (OR 2.1, 95%CI 1.3-3.3; and OR 1.8, 95%CI 1.5-2.1, respectively). CONCLUSIONS Factors associated with fewer visits to screening were similar for both groups of women, except for language which was significant only for Indigenous women, and remoteness which was significant only for non-Indigenous women. Implications for public health: Health communication in Indigenous languages may be key in encouraging participation and retaining Indigenous women in BreastScreen; improving access for remote-living non-Indigenous women should also be addressed.
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Affiliation(s)
- Kriscia A Tapia
- Faculty of Health Sciences, The University of Sydney, New South Wales
| | - Gail Garvey
- Faculty of Health Sciences, The University of Sydney, New South Wales.,Charles Darwin University, Wellbeing and Preventable Chronic Diseases Division Menzies School of Health Research, Northern Territory
| | - Mark F McEntee
- Department of Medicine, University College Cork, Ireland
| | - Mary Rickard
- Faculty of Health Sciences, The University of Sydney, New South Wales.,BreastScreen New South Wales
| | | | - Patrick C Brennan
- Faculty of Health Sciences, The University of Sydney, New South Wales
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Lofters AK, McBride ML, Li D, Whitehead M, Moineddin R, Jiang L, Grunfeld E, Groome PA. Disparities in breast cancer diagnosis for immigrant women in Ontario and BC: results from the CanIMPACT study. BMC Cancer 2019; 19:42. [PMID: 30626375 PMCID: PMC6327524 DOI: 10.1186/s12885-018-5201-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Canada, clinical practice guidelines recommend breast cancer screening, but there are gaps in adherence to recommendations for screening, particularly among certain hard-to-reach populations, that may differ by province. We compared stage of diagnosis, proportion of screen-detected breast cancers, and length of diagnostic interval for immigrant women versus long-term residents of BC and Ontario. METHODS We conducted a retrospective cohort study using linked administrative databases in BC and Ontario. We identified all women residing in either province who were diagnosed with incident invasive breast cancer between 2007 and 2011, and determined who was foreign-born using the Immigration Refugee and Citizenship Canada database. We used descriptive statistics and bivariate analyses to describe the sample and study outcomes. We conducted multivariate analyses (modified Poisson regression and quantile regression) to control for potential confounders. RESULTS There were 14,198 BC women and 46,952 Ontario women included in the study population, of which 11.8 and 11.7% were foreign-born respectively. In both provinces, immigrants and long-term residents had similar primary care access. In both provinces, immigrant women were significantly less likely to have a screen-detected breast cancer (adjusted relative risk 0.88 [0.79-0.96] in BC, 0.88 [0.84-0.93] in Ontario) and had a significantly longer median diagnostic interval (2 [0.2-3.8] days in BC, 5.5 [4.4-6.6] days in Ontario) than long-term residents. Women from East Asia and the Pacific were less likely to have a screen-detected cancer and had a longer diagnostic interval, but were diagnosed at an earlier stage than long-term residents. In Ontario, women from Latin America and the Caribbean and from South Asia were less likely to have a screen-detected cancer, had a longer median diagnostic interval, and were diagnosed at a later stage than long-term residents. These findings were not explained by access to primary care. CONCLUSIONS There are inequalities in breast cancer diagnosis for Canadian immigrant women. We have identified particular immigrant groups (women from Latin America and the Caribbean and from South Asia) that appear to be subject to disparities in the diagnostic process that need to be addressed in order to effectively reduce gaps in care.
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Affiliation(s)
- A. K. Lofters
- Department of Family & Community Medicine, St. Michael’s Hospital, 30 Bond St, Toronto, M5B 1W8 Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - M. L. McBride
- BC Cancer, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - D. Li
- BC Cancer, Vancouver, Canada
| | | | - R. Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - L. Jiang
- ICES, Queen’s University, Kingston, Canada
- Critical Care Services Ontario, Toronto, Ontario Canada
| | - E. Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, ON Canada
| | - P. A. Groome
- ICES, Queen’s University, Kingston, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- Cancer Research Institute, Queen’s University, Kingston, Canada
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Chiva Giurca B, Hamilton W, Martins T. The impact of health literacy on diagnosis and outcomes of symptomatic cancer by ethnicity: a systematic review protocol. Syst Rev 2018; 7:164. [PMID: 30326949 PMCID: PMC6192147 DOI: 10.1186/s13643-018-0831-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/01/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Ethnic minorities in multi-ethnic societies like the UK and USA have poorer outcomes for some cancer types when compared with the majority. The causes of ethnic inequalities in cancer outcomes are complex and not fully understood. In particular, the potential role of health literacy on symptomatic presentation and diagnostic interval (the period between first consultation within primary care and definitive diagnosis of cancer) by ethnicity is unknown. Given the increasing need for shared decision-making and patient involvement in the diagnostic process, understanding the potential impact of the differences in health literacy may help redress ethnic inequality in cancer outcomes. The present study aims to critically examine the evidence in this area. METHODS Seven electronic databases will be searched using keywords and controlled vocabulary related to ethnicity, health literacy, cancer diagnosis and cancer outcomes. Citations and bibliography searches of included studies will be performed to identify relevant studies that have cited eligible articles. Authors of included studies will be contacted to identify unpublished studies. Eligible studies will be restricted to primary cancers. Study quality will be evaluated in using the Critical Appraisal Skills Programme (CASP) checklists. A descriptive summary of selected studies will be presented, and the synthesis will follow a narrative framework. DISCUSSION This systematic review will summarise the evidence regarding ethnic inequality in health literacy and how this impacts on diagnosis and outcomes of cancer. The review will identify possible areas for future research, and inform clinical practice and interventions to reduce ethnic inequalities in cancer diagnosis and outcomes.
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Affiliation(s)
- Bogdan Chiva Giurca
- University of Exeter Medical School, Room G02 Medical School Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - William Hamilton
- University of Exeter Medical School, Room G02 Medical School Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Tanimola Martins
- University of Exeter Medical School, Room G02 Medical School Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Female Veterans With Diagnoses of Both Chronic Pelvic Pain and Overactive Bladder; How Do They Compare to Women Diagnosed With Interstitial Cystitis? Female Pelvic Med Reconstr Surg 2018; 26:591-593. [PMID: 29746393 DOI: 10.1097/spv.0000000000000597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to compare women with a known diagnosis of interstitial cystitis (IC) to a population that might be at risk for the diagnosis of IC, women with diagnoses of both chronic pelvic pain (CPP) and overactive bladder (OAB). METHODS We conducted a retrospective study of data from the Veterans Affairs Corporate Data Warehouse. The cohort included all female veterans who had established care with a primary care provider from 1997 to present. International Classification of Diseases, Ninth Revision codes were used to identify women with a diagnosis of IC, CPP, and OAB. Demographic data and comorbidities were compared between groups. RESULTS A total of 596,815 women were identified. Two thousand three hundred one women (0.4%) were diagnosed with IC; 4459 women (0.7%) were diagnosed with CPP and OAB. At baseline, women with OAB and CPP were more likely to identify as minority (P < 0.001). Anxiety (57.3% vs 49.5%), depression (39.0% vs 46.0%), and posttraumatic stress disorder (29.7 vs 26.4%) were all more common in the CPP and OAB group than in the IC group. In the multivariable model, women with CPP and OAB were more likely to identify as a minority, use tobacco, and carry a diagnosis of anxiety. CONCLUSIONS There were more patients diagnosed with CPP and OAB compared with patients diagnosed with IC in this population of female veterans. Given the high rate of comorbid anxiety and depression in both groups, further study is warranted to determine whether these women are misdiagnosed.
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Joffe M, Ayeni O, Norris SA, McCormack VA, Ruff P, Das I, Neugut AI, Jacobson JS, Cubasch H. Barriers to early presentation of breast cancer among women in Soweto, South Africa. PLoS One 2018; 13:e0192071. [PMID: 29394271 PMCID: PMC5796726 DOI: 10.1371/journal.pone.0192071] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/16/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Reported breast cancer incidence is rising in South Africa, where some women are diagnosed late and have poor outcomes. We studied patient and provider factors associated with clinical stage at diagnosis among women diagnosed at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg in 2015-2016. METHODS From face-to-face interviewer-administered questionnaires we compared self-reported socioeconomics, demographics, comorbidities, risk factors, personal and health system barriers, and from patient clinical records, clinical staging, receptor subtype, and tumor grade among 499 consecutive women newly diagnosed with advanced stage (III/IV) breast cancer versus those diagnosed early (stage 0/I/II). Logistic regression models were used to identify factors associated with advanced stage at diagnosis. RESULTS Among the women, 243 (49%) were diagnosed at early and 256 (51%) at advanced stages. In the multiple logistic regression adjusted model, completion of high school or beyond (odds ratio (OR) 0.59, and greater breast cancer knowledge and awareness (OR 0.86) were associated with lower stage of breast cancer at presentation. Advanced stage was associated with Luminal B (OR 2.25) and triple-negative subtypes (OR 3.17) compared to luminal A, with delays >3 months from first breast symptoms to accessing the health system (OR 2.79) and with having more than 1 visit within the referral health system (OR 3.19) for 2 visits; OR 2.73 for ≥3 visits). CONCLUSIONS Limited patient education, breast cancer knowledge and awareness, and health system inefficiencies were associated with advanced stage at diagnosis. Sustained community and healthcare worker education may down-stage disease and improve cancer outcomes.
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Affiliation(s)
- Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Oluwatosin Ayeni
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
| | - Shane Anthony Norris
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Valerie Ann McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Paul Ruff
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Division of Medical Oncology, Department Internal Medicine, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Ishani Das
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States of America
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States of America
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Judith S. Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Herbert Cubasch
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Mohd Mujar NM, Dahlui M, Emran NA, Abdul Hadi I, Wai YY, Arulanantham S, Hooi CC, Mohd Taib NA. Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia. PLoS One 2017; 12:e0176394. [PMID: 28448541 PMCID: PMC5407802 DOI: 10.1371/journal.pone.0176394] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Complementary and alternative medicine (CAM) is widely used among the breast cancer patients in Malaysia. Delays in presentation, diagnosis and treatment have been shown to impact the disease prognosis. There is considerable use of CAM amongst breast cancer patients. CAM use has been cited as a cause of delay in diagnosis and treatments in qualitative studies, however there had not been any confirmatory study that confirms its impact on delays. The purpose of this study was to evaluate whether the use of CAM among newly diagnosed breast cancer patients was associated with delays in presentation, diagnosis or treatment of breast cancer. This multi-centre cross-sectional study evaluating the time points of the individual breast cancer patients' journey from first visit, resolution of diagnosis and treatments was conducted in six public hospitals in Malaysia. All newly diagnosed breast cancer patients from 1st January to 31st December 2012 were recruited. Data were collected through medical records review and patient interview by using a structured questionnaire. Complementary and alternative medicine (CAM) was defined as the use of any methods and products not included in conventional allopathic medicine before commencement of treatments. Presentation delay was defined as time taken from symptom discovery to first presentation of more than 3 months. The time points were categorised to diagnosis delay was defined as time taken from first presentation to diagnosis of more than 1 month and treatment delay was defined as time taken from diagnosis to initial treatment of more than 1 month. Multiple logistic regression was used for analysis. A total number of 340 patients participated in this study. The prevalence of CAM use was 46.5% (n = 158). Malay ethnicity (OR 3.32; 95% CI: 1.85, 5.97) and not interpreting symptom as cancerous (OR 1.79; 95% CI: 1.10, 2.92) were significantly associated with CAM use. The use of CAM was associated with delays in presentation (OR 1.65; 95% CI: 1.05, 2.59), diagnosis (OR 2.42; 95% CI: 1.56, 3.77) and treatment of breast cancer (OR 1.74; 95% CI: 1.11, 2.72) on univariate analyses. However, after adjusting with other covariates, CAM use was associated with delays in presentation (OR 1.71; 95% CI: 1.05, 2.78) and diagnosis (OR 2.58; 95% CI: 1.59, 4.17) but not for treatment of breast cancer (OR 1.58; 95% CI: 0.98, 2.55). The prevalence of CAM use among the breast cancer patients was high. Women of Malay ethnicity and not interpreting symptom as cancerous were significantly associated with CAM use. The use of CAM is significantly associated with delay in presentation and resolution of diagnosis. This study suggests further evaluation of access to breast cancer care is needed as poor access may cause the use of CAM. However, since public hospitals in Malaysia are heavily subsidized and readily available to the population, CAM use may impact delays in presentation and diagnosis.
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Affiliation(s)
- Noor Mastura Mohd Mujar
- Cluster of Healthy Lifestyle, Advanced Medical and Dental Institute, University Science of Malaysia, Penang, Malaysia
| | - Maznah Dahlui
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tapia KA, Garvey G, Mc Entee M, Rickard M, Brennan P. Breast Cancer in Australian Indigenous Women: Incidence,
Mortality, and Risk Factors. Asian Pac J Cancer Prev 2017; 18:873-884. [PMID: 28545182 PMCID: PMC5494235 DOI: 10.22034/apjcp.2017.18.4.873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Indigenous people of Australia face significant health gaps compared with the general population, with lower life
expectancies, higher rates of death, and chronic illness occurring more often than in non-indigenous Australians. Cancer
is the second largest contributor to the burden of disease with breast cancer being the most common invasive cancer
diagnosed for females. Despite a lower breast cancer incidence compared with non-indigenous women, fatalities occur
at an elevated rate and breast cancers have an earlier age of onset. For indigenous women there are also more advanced
and distant tumours at diagnosis, fewer hospitalisations for breast cancer, and lower participation in breast screening.
Concomitantly there are demographic, socio-economic and lifestyle factors associated with breast cancer risks that
are heavily represented within Indigenous communities. The aim of this two-part narrative review is to examine the
available evidence on breast cancer and its risk factors in Australian Indigenous women. Part One presents a summary
of the latest incidence, survival and mortality data. Part Two presents the risk factors most strongly associated with
breast cancer including age, place of residence, family risk, genetics, reproductive history, tobacco use, alcohol intake,
physical activity, participation in screening and breast density. With increasing emphasis on personalized health care, a
clear understanding of breast cancer incidence, survival, mortality, and causal agents within the Indigenous population
is required if breast cancer prevention and management is to be optimized for Indigenous Australians.
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Affiliation(s)
- Kriscia A Tapia
- Faculty of Health Sciences, The University of Sydney, New South Wales, Australia.
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Abstract
Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. In this Review, we examine expedited diagnosis of cancer from four perspectives. The first relates to the potential for clinical benefits of expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in the primary-care setting, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for identification of such patients; UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of expedited diagnosis are reviewed, although few studies provide definitive evidence on this topic.
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Affiliation(s)
- Willie Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Fiona M Walter
- Department of Public Health &Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Greg Rubin
- School of Medicine, Pharmacy and Health, Wolfson Building, Queen's Campus, University of Durham, Stockton-on-Tees TS17 6BH, UK
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK
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Inadequate critical appraisal of studies in systematic reviews of time to diagnosis. J Clin Epidemiol 2016; 78:43-51. [DOI: 10.1016/j.jclinepi.2016.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 03/02/2016] [Accepted: 03/21/2016] [Indexed: 01/07/2023]
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Licqurish S, Phillipson L, Chiang P, Walker J, Walter F, Emery J. Cancer beliefs in ethnic minority populations: a review and meta-synthesis of qualitative studies. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27515153 DOI: 10.1111/ecc.12556] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/29/2022]
Abstract
People from ethnic minorities often experience poorer cancer outcomes, possibly due to later presentation to healthcare and later diagnosis. We aimed to identify common cancer beliefs in minority populations in developed countries, which can affect symptom appraisal and help seeking for symptomatic cancer. Our systematic review found 15 relevant qualitative studies, located in the United Kingdom (six), United States (five), Australia (two) and Canada (two) of African, African-American, Asian, Arabic, Hispanic and Latino minority groups. We conducted a meta-synthesis that found specific emotional reactions to cancer, knowledge and beliefs and interactions with healthcare services as contributing factors in help seeking for a cancer diagnosis. These findings may be useful to inform the development of interventions to facilitate cancer diagnosis in minority populations.
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Affiliation(s)
- S Licqurish
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - L Phillipson
- Centre for Health Initiatives, University of Wollongong, Wollongong, NSW, Australia
| | - P Chiang
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - J Walker
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - F Walter
- Department of Public Health and Primary Care, Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - J Emery
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
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Affiliation(s)
- Tanimola Martins
- College House St Luke's Campus, University of Exeter Medical School, Magdalen Road, Exeter EX1 2LU, UK.
| | - William Hamilton
- College House St Luke's Campus, University of Exeter Medical School, Magdalen Road, Exeter EX1 2LU, UK
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Asthana S, Gibson A, Bailey T, Moon G, Hewson P, Dibben C. Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sheena Asthana
- School of Government, University of Plymouth, Plymouth, UK
| | - Alex Gibson
- School of Government, University of Plymouth, Plymouth, UK
| | - Trevor Bailey
- College of Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Graham Moon
- School of Geography and the Environment, University of Southampton, Southampton, UK
| | - Paul Hewson
- School of Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, UK
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Missed Opportunities for the Diagnosis of Colorectal Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:285096. [PMID: 26504796 PMCID: PMC4609372 DOI: 10.1155/2015/285096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/24/2015] [Accepted: 04/28/2015] [Indexed: 01/18/2023]
Abstract
Objective. To examine patient and medical characteristics which predict a missed diagnostic opportunity (MDO) for colorectal cancer (CRC). Methods. The sample consisted of 252 patients diagnosed with Stages 1–4 CRC who were diagnosed in the prior six months, had experienced symptoms prior to diagnosis, and were not diagnosed through routine screening. Systematic review of all medical records prior to patients' diagnosis was conducted. An MDO was defined as a clinical encounter where, even in the presence of presumptive CRC symptoms, the CRC diagnostic process is not started. Results. 92 patients (36.5%) experienced an MDO. Almost 80% of alternate diagnoses were other GI-GU diseases, including hemorrhoids and diverticulitis. Stomach pain, anemia, and constipation were the most common symptoms experienced by the MDO group. These symptoms, and weight loss and vomiting, were more likely to be noted in the charts of the MDO patients (P < 0.04). Independent risk factors for MDO included age (<50) [OR = 2.29 (1.14–4.60), P = 0.02] and female sex [OR = 2.19 (1.16–4.16), P = 0.03]. Each additional physician seen, more than doubled the MDO risk [OR = 2.05 (1.53–2.74), P < 0.001]. Conclusions. Females, younger patients, and those consulting more physicians were all more likely to experience an MDO. Continued increased training of physicians to enhance knowledge of who is vulnerable to CRC is needed in addition to an increased focus to adherence to screening recommendations.
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Freitas AGQ, Weller M. Patient delays and system delays in breast cancer treatment in developed and developing countries. CIENCIA & SAUDE COLETIVA 2015; 20:3177-89. [DOI: 10.1590/1413-812320152010.19692014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 01/31/2015] [Indexed: 01/12/2023] Open
Abstract
AbstractDelays in treating breast cancer have been associated with a more advanced stage of the disease and a decrease in patient survival rates. The scope of this integrative review was to analyze the main causal factors and types of patient and system delays. The underlying causal factors of delays were compared among studies conducted in developing and developed countries. Of the 53 studies selected, 24 were carried out in developing countries and 29 in developed countries, respectively. Non-attribution of symptoms to cancer, fear of the disease and treatment and low educational level were the most frequent causes of patient delay. Less comprehensive health insurance coverage, older/younger age and false negative diagnosis tests were the three most common causal factors of system delay. The effects of factors such as age were not decisive per se and depended mainly on the social and cultural context. Some factors caused both patient delay and system delay. Studies conducted in developing countries identified more causal factors of patient delay and had a stronger focus on patient delay or the combination of both. Studies conducted in developed countries had a stronger focus on aspects of system delay during treatment and guidance of breast cancer patients in the health care system.
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Martins T, Ukoumunne OC, Banks J, Raine R, Hamilton W. Ethnic differences in patients' preferences for prostate cancer investigation: a vignette-based survey in primary care. Br J Gen Pract 2015; 65:e161-70. [PMID: 25733437 PMCID: PMC4337304 DOI: 10.3399/bjgp15x683965] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/30/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Minority ethnic groups in the UK have worse outcomes for some cancer types compared with the white majority. Black males have worse staging at diagnosis of prostate cancer and often present as emergencies, suggesting possible delays in the diagnostic pathway. Delay may arise from lower awareness of cancer symptoms, reluctance to report symptoms, reduced desire for investigation, or a combination of these. Reduced desire for investigation was examined in this study AIM To investigate whether black males in the UK would choose to be tested for prostate cancer compared with the white majority. DESIGN AND SETTING A vignette (hypothetical scenario)-based, electronic survey of male patients aged ≥40 years from four general practices in Bristol, UK. METHOD The vignettes described possible prostate cancer symptoms (equating to risk levels of 2%, 5%, and 10%), investigative procedures, and possible outcomes. Participants indicated whether they would choose investigation in these scenarios. Analysis used logistic regression, with preference for investigation as the outcome variable and ethnicity as the main explanatory variable. RESULTS In total, 449 (81%) of 555 participants opted for investigation, regardless of risk levels; of these, the acceptance rate was 94% (251 out of 267) among white males and 70% (198 out of 285) among black males. In multivariable analyses, preference for investigation was lower in black males, even after controlling for relevant confounding factors including specific risk level (odds ratio 0.13; 95% confidence interval = 0.07 to 0.25; P<0.001). CONCLUSION Black males are less likely to opt for investigation at any risk level of prostate cancer compared with white males. This may explain some of their late-stage presentation at diagnosis and subsequent poorer outcomes.
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Koffman J, Ho YK, Davies J, Gao W, Higginson IJ. Does ethnicity affect where people with cancer die? A population-based 10 year study. PLoS One 2014; 9:e95052. [PMID: 24751724 PMCID: PMC3994011 DOI: 10.1371/journal.pone.0095052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 03/22/2014] [Indexed: 11/19/2022] Open
Abstract
Background Ageing is a growing issue for people from UK black, Asian and minority ethnic (BAME) groups. The health experiences of these groups are recognised as a ‘tracer’ to measure success in end of life patient-preferred outcomes that includes place of death (PoD). Aim To examine patterns in PoD among BAME groups who died of cancer. Material and Methods Mortality data for 93,375 cancer deaths of those aged ≥65 years in London from 2001–2010 were obtained from the UK Office for National Statistics (ONS). Decedent's country of birth was used as a proxy for ethnicity. Linear regression examined trends in place of death across the eight ethnic groups and Poisson regression examined the association between country of birth and place of death. Results 76% decedents were born in the UK, followed by Ireland (5.9%), Europe(5.4%) and Caribbean(4.3%). Most deaths(52.5%) occurred in hospital, followed by home(18.7%). During the study period, deaths in hospital declined with an increase in home deaths; trend for time analysis for those born in UK(0.50%/yr[0.36–0.64%]p<0.001), Europe (1.00%/yr[0.64–1.30%]p<0.001), Asia(1.09%/yr[0.94–1.20%]p<0.001) and Caribbean(1.03%/yr[0.72–1.30%]p<0.001). However, time consistent gaps across the geographical groups remained. Following adjustment hospital deaths were more likely for those born in Asia(Proportion ratio(PR)1.12[95%CI1.08–1.15]p<0.001) and Africa(PR 1.11[95%CI1.07–1.16]p<0.001). Hospice deaths were less likely for those born in Asia(PR 0.73 [0.68–0.80] p<0.001), Africa (PR 0.83[95%CI0.74–0.93]p<0.001), and ‘other’ geographical regions (PR0.90[95% 0.82–0.98]p<0.001). Home deaths were less likely for those born in the Caribbean(PR0.91[95%CI 0.85–0.98]p<0.001). Conclusions Location of death varies by country of birth. BAME groups are more likely to die in a hospital and less likely to die at home or in a hospice. Further investigation is needed to determine whether these differences result from patient-centred preferences, or other environment or service-related factors. This knowledge will enable strategies to be developed to improve access to relevant palliative care and related services, where necessary.
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Affiliation(s)
- Jonathan Koffman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
- * E-mail:
| | - Yuen King Ho
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Joanna Davies
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Wei Gao
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Irene J. Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
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