Socioeconomic status and lifestyle patterns in the most common cancer types-community-based research

Association of health literacy with cancer survival: a single-centre prospective cohort study

BACKGROUND AND PURPOSE

Health literacy is defined as the ability to find, understand and use health information for informed decision. The role of health literacy in treatment decisions and outcome remains largely unexplored. This study sought out to assess the effect of individual health literacy on overall survival (OS) in cancer patients in Ostrobothnia.

MATERIAL AND METHODS

The present study is a follow-up of a cross-sectional survey study performed during December 2021 and March 2022. The survey assessed socioeconomic factors, lifestyle factors and self-reported health literacy. The follow-up included data on recorded death, cause of death, performance status (PS), clinical frailty scale, Charlson comorbidity index and body mass index. The sample size for this study was 400 participants, and any participant with a malignancy was eligible for the study.

RESULTS

Low health literacy was associated with increased risk of death. The disparity remained after adjustments for age, sex, comorbidities, PS, stage and hazard ratios (HR) = 1.47 (1.01-2.14). After adjustments for lifestyle patterns, the disparity remained, HR = 1.49 (1.03-2.17). The difference diminished after adjustments for cancer types. The median OS was 3.6 months longer for those with medium-high health literacy than those with low health literacy.

INTERPRETATION

The results indicated health literacy having a direct, clinically significant, effect on OS, which is likely not explained by differences in cancer entity alone. Future studies should focus on assessing whether an intervention aiming to improve health literacy may improve overall cancer survival.

Dietary self-management behavior and associated factors among breast cancer patients receiving chemotherapy: A latent profile analysis

PURPOSE

Breast cancer patients experience more gastrointestinal symptoms during chemotherapy than during the survival period post-treatment. This can interfere with daily dietary intake and increase the risk of malnutrition. This study aimed to evaluate the level and classification of dietary self-management behavior and the influence of self-care self-efficacy, outcome expectations, treatment self-regulation and perceived social support guided by "Integrated theory of Health Behavior Change".

METHODS

A multicenter cross-sectional study was conducted. The assessment tools included self-designed demographic and clinical instruments, Dietary Management Behavior Questionnaire, Strategies Used by People to Promote Health, Consideration of Future Consequences Scale-Food, the Treatment Self-regulation Questionnaire and Perceived Social Support Scale.

RESULTS

A total of 760 samples were analysed. The best-fitting model of the 4 classes was determined, with the lowest-to-highest scores as follows: Class 1-poor behavior group (17.84%), Class 2-medium behavior group (28.26%), Class 3-good behavior group (22.67%) and Class 4-excellent behavior group (31.23%). In the control group, being underweight (OR = 0.131), having no spouse (OR = 0.235), having a lower educational level (OR = 0.147-0.384), being premenopausal (OR = 0.220-0.255), having immediate consequence considerations (OR = 0.866-0.909) and receiving other support (OR = 0.830) were risk factors (all P < 0.05).

CONCLUSIONS

The performance of dietary self-management behavior needs to be improved. This study may provide a reference for determining key intervention populations that are underweight during premenopause, have no spouse and have lower education. Specific intervention content, including future consequence consideration, positive attitudes, decision-making, autonomous motivation, introjected regulation and friend support, should be added to improve the dietary practices during chemotherapy precisely.

Narrowing the Gap: Understanding Lung Cancer Care Intervals and Their Barriers in Latin American Low and Middle-Income Countries

BACKGROUND AND AIMS

Barriers in lung cancer (LC) management impact patient care and their outcomes, yet studies from high-income countries may not be fully applicable to low- and middle-income countries (LMICs) with distinct healthcare challenges. This study aims to characterize LC care intervals and their barriers in a Latin American LMIC.

METHODS

This analysis of patients with LC diagnosed between 2003 and 2016 at a national cancer referral center, calculated the duration of the following six intervals: from symptom onset to first specialist visit (StFS), first specialist visit to diagnosis (FStDX), diagnosis to treatment initiation (DXtTX), symptom onset to diagnosis (StDX), first specialist visit to treatment (FStTX), and symptom onset to treatment (StTX). Clinicopathological and sociodemographic characteristics were extracted from electronic medical records. Multivariate Cox regression was used to identify factors associated with the duration of each care interval.

RESULTS

503 patients were included; the majority were females (52.7%), with adenocarcinoma (76%) and a positive smoking status (56%). The median duration in days (interquartile range [IQR]) of StFS, FStDX, DXtTX, StDX, FStTX, and StTX were 90 (142), 34 (63), 17 (25), 148 (149), 60 (79), and 173 (153), respectively. In multivariate analyses, factors associated with the length of care intervals were sex, marital status, disease stage, mutational status, asbestos, and wood smoke exposure. After adjustment, sex remained a statistically significant predictor of longer intervals.

CONCLUSION

Our findings support the identification of barriers and the development of interventions aimed at shortening LC care intervals, particularly among disadvantaged individuals who are more likely to experience delays.

Equality, Diversity and Inclusion characteristics measured or reported in randomised trials of intrapartum interventions: A Scoping Review

Background

Equality, diversity and inclusion (EDI) has gained discursive momentum across multiple arenas, including in maternal health research. As a preliminary exploration for future discussion and development, we undertook a scoping review to identify the types, frequency, and extent of EDI characteristics that were measured and reported in randomised controlled trials (RCTs) of intrapartum interventions specifically.

Methods

Joanna Briggs Institute methodological guidance for scoping reviews guided the conduct of the review. The population were women of any parity and risk category who were enrolled in intrapartum RCTs in any birth setting or geographical location. The concept was measured and reported EDI characteristics. CINAHL, MEDLINE, PsycINFO, EMBASE, and CENTRAL were searched from January 2019 to March 2024. Data were extracted using a pre-designed form. The findings were summarised and narratively reported supported by illustrative tables and graphs.

Results

Two-hundred and forty-seven RCTs from 49 countries were included. Eleven EDI characteristics were measured or reported in at least one RCT, although frequency varied. Religion, for example, featured in three RCTs only, whereas Age featured in 222 RCTs. How the EDI characteristics featured also varied. Race/Ethnicity, for example, was described in 21 different ways in 25 RCTs. Similarly, Education was reported in 62 different ways across 96 RCTs. Ninety RCTs limited inclusion to nulliparous participants only, six RCTs required participants to have a minimum educational level, 127 RCTs had inclusion age cut-offs although 23 different variations of this were noted and 15 RCTs excluded participants on the grounds of disability.

Conclusions

This scoping review highlights EDI characteristic measurement and reporting deficits in intrapartum RCTs. There is a critical need for improvements in designing, conducting, and reporting RCTs to incorporate EDI. By adopting more extensive EDI practices a greater understanding of healthcare treatments and innovations leading to enhanced maternal health equity could be achieved.

Disease burden of trachea, bronchus and lung cancer 1990-2021 and global trends projected to 2035

Tracheal, bronchial, and lung cancer (TBL) is among the most common malignancies worldwide, with persistently high incidence and mortality rates, posing a significant threat to public health. However, existing studies on TBL disease burden are often limited to specific regions or short-term trends, lacking systematic and predictive analyses. This study comprehensively evaluated the global, regional, and national burden of TBL across 204 countries and territories from 1990 to 2021, utilizing predictive models to estimate trends from 2022 to 2035. This study used data from the Global Burden of Disease (GBD) 2021 database to systematically analyze the prevalence (ASPR), incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) associated with TBL. Age-standardized rates (ASR) were used to quantify disease burden. Historical trends were assessed using Joinpoint regression analysis, while ARIMA and Bayesian age-period-cohort (BAPC) models were employed to predict future trends. The study also incorporated the Sociodemographic Index (SDI) to investigate the impact of socioeconomic development on TBL burden. In 2021, the global ASPR, ASIR, ASMR, and DALYs for TBL were 37.28, 26.43, 23.50, and 638.60 per 100,000 population, respectively. From 1990 to 2021, ASPR increased slightly (0.09 per 100,000), while ASIR, ASMR, and DALYs declined by 0.07, 0.15, and 0.23 per 100,000, respectively. Regionally, the highest ASPR was observed in the high-income Asia-Pacific region (69.79 per 100,000), while East Asia recorded the highest ASIR (43.41 per 100,000) and ASMR (38.53 per 100,000). Sub-Saharan Africa had the lowest burden. Gender analysis showed that males had a significantly higher TBL burden than females, but their burden declined over the study period. In contrast, females, particularly in older age groups, experienced an increase in burden. Future predictions indicate that the overall TBL burden will decline between 2022 and 2035; however, the burden among females and older adults is projected to rise, with a marked increase in female ASPR. This study highlights the global and regional trends in TBL burden from 1990 to 2021 and provides predictions for future burden. Although the overall burden is declining, significant disparities exist across genders and regions, with East Asia and high-income North America warranting particular attention. Females and older adults are priority groups for future interventions. The findings underscore the importance of early screening, targeted interventions, and region-specific strategies to optimize public health policies, resource allocation, and tailored prevention efforts.

Trends and cross-country inequality in the incidence of GI cancers among the working-age population from 1990 to 2021: a Global Burden of Disease 2021 analysis

BACKGROUND

GI cancers pose an increasing global health burden, with their impact on the working-age population (WAP) aged 15-64 years remaining largely unexplored despite the crucial role of this group in societal and economic well-being.

OBJECTIVE

To assess trends and cross-country inequality in the global burden of six GI cancers from 1990 to 2021 among individuals in the WAP.

DESIGN

The 2021 Global Burden of Disease study dataset was used to obtain estimates of GI cancer incidence and 95% uncertainty intervals, including the number of cases, crude incidence rate and age-standardised incidence rate (ASIR). WAP GI cancer epidemiology was assessed at the national, regional and global levels, evaluating trends from 1990 to 2021 from overall, local and Sociodemographic Index (SDI) perspectives and using standard health equity methods to quantify cross-country inequality.

RESULTS

Colorectal cancer exhibited the greatest burden of GI cancer among the WAP in 2021. From 1990 to 2021, the number of GI cancer cases rose by 51.9%, although the ASIR declined by 23.4%. These rates exhibit geographic variation, with the most cases and the highest ASIR in China and Mongolia, respectively. Incidence was disproportionately concentrated in higher SDI countries, and worsening inequality was evident over time.

CONCLUSIONS

While the ASIR of GI cancer is trending downwards among the WAP, high incidence rates, regional variability and an unequal burden of disease emphasise the need for flexible, targeted medical interventions to support policymaking and medical resource allocation.

Causal Relationship Between Physical Activity and Thymic Tumors Mediated by Circulating Cytokines: A Mendelian Randomization Mediation Analysis

Physical activity reduces chronic disease risk and enhances immune function, but its causal relationship with thymic tumors-rare neoplasms of the anterior mediastinum-remains unclear. This study investigated whether physical activity reduces thymic tumor risk and whether circulating cytokines mediate this effect. We performed a two-sample Mendelian randomization (MR) analysis using genetic variants as instrumental variables for physical activity and cytokines. Data were obtained from large genome-wide association studies of Europeans, and included the following: physical activity (91,084 individuals), thymic tumors (473,681 individuals with 58 benign and 93 malignant cases), and cytokines (14,824 individuals). The inverse-variance weighted method served as the primary analysis. Genetically predicted physical activity was associated with reduced risks of benign (odds ratio [OR] = 0.381; 95% confidence interval [CI]: 0.158 to 0.921; p = 0.032) and malignant thymic tumors (OR = 0.312; 95% CI: 0.155 to 0.628; p = 0.001). Mediation analysis identified interleukin-10 receptor subunit β (IL10RB) as a partial mediator, accounting for 5.95% of the protective effect on benign tumors. Sensitivity analyses indicated no pleiotropy or heterogeneity. In conclusion, physical activity causally reduces the risk of thymic tumors, partially mediated by IL10RB, highlighting its potential role in cancer prevention through immunomodulation.

New Challenges in Bladder Cancer Diagnosis: How Biosensing Tools Can Lead to Population Screening Opportunities

Bladder cancer is one of the most common cancers worldwide. Despite its high incidence, cystoscopy remains the currently used diagnostic gold standard, although it is invasive, expensive and has low sensitivity. As a result, the cancer diagnosis is mostly late, as it occurs following the presence of hematuria in urine, and population screening is not allowed. It would therefore be desirable to be able to act promptly in the early stage of the disease with the aid of biosensing. The use of devices/tools based on genetic assessments would be of great help in this field. However, the genetic differences between populations do not allow accurate analysis in the context of population screening. Current research is directed towards the discovery of universal biomarkers present in urine with the aim of providing an approach based on a non-invasive, easy-to-perform, rapid, and accurate test that can be widely used in clinical practice for the early diagnosis and follow-up of bladder cancer. An efficient biosensing device may have a disruptive impact in terms of patient health and disease management, contributing to a decrease in mortality rate, as well as easing the social and economic burden on the national healthcare system. Considering the advantage of accessing population screening for early diagnosis of cancer, the main challenges and future perspectives are critically discussed to address the research towards the selection of suitable biomarkers for the development of a very sensitive biosensor for bladder cancer.

Psychometric Characteristics of the Quality of Oncology Nursing Care Scale (QONCS): A Validation Study

OBJECTIVES

Quality care in healthcare settings shortens hospitalization, reduces infection rates and complication risks, and improves patients' ability to manage their symptoms. Due to the absence of tools for assessing care quality in Italian oncology settings, this study aimed to evaluate the psychometric properties of the Italian version of the Quality of Oncology Nursing Care Scale (QONCS).

METHODS

The study comprised 4 phases. Phase I involved cultural adaptation of the QONCS following Brislin's model. In phase II, 6 external experts assessed the instrument's face and content validities. In phase III, a cross-sectional study was conducted at 3 hospitals from February to September 2023. In phase IV, factor analyses were performed using exploratory structural equation modeling.

RESULTS

The 5-dimensional structure of the adapted QONCS showed a good fit based on the following statistics: χ2 (324, N = 219) = 704.690, P < .001; root mean square error of approximation = 0.059 (90% confidence interval [CI] = 0.52-0.66), P < .001; comparative fit index = 0.935; Tucker-Lewis index = 0.908; standardized root mean square residual = 0.026. McDonald's ω (0.968) indicated satisfactory internal consistency. The test-retest reliability demonstrated a high and significant positive correlation. Correlation analysis revealed that age, marital status, and employment status were significantly and positively associated with the QONCS score.

CONCLUSION

This study confirms the validity and reliability of the QONCS. We recommend using the QONCS to thoroughly assess nursing care quality and identify factors that influence the delivery of high-quality care in oncology settings.

IMPLICATIONS FOR NURSING PRACTICE

Our findings highlight the value of the QONCS in helping nurses assess and improve perceived care quality among patients with cancer. Valid and reliable tools, such as the QONCS, are crucial for guiding policies to enhance patient care.

Prognosis and risk factor assessment of patients with advanced lung cancer with low socioeconomic status: model development and validation

BACKGROUND

Lung cancer, a major global health concern, disproportionately impacts low socioeconomic status (SES) patients, who face suboptimal care and reduced survival. This study aimed to evaluate the prognostic performance of traditional Cox proportional hazards (CoxPH) regression and machine learning models, specifically Decision Tree (DT), Random Forest (RF), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost), in patients with advanced lung cancer with low SES.

DESIGN

A retrospective study.

METHOD

The 949 patients with advanced lung cancer with low SES who entered the hospice ward of a tertiary hospital in Wuhan, China, from January 2012 to December 2021 were randomized into training and testing groups in a 3:1 ratio. CoxPH regression methods and four machine learning algorithms (DT, RF, SVM, and XGBoost) were used to construct prognostic risk prediction models.

RESULTS

The CoxPH regression-based nomogram demonstrated reliable predictive accuracy for survival at 60, 90, and 120 days. Among the machine learning models, XGBoost showed the best performance, whereas RF had the lowest accuracy at 60 days, DT at 90 days, and SVM at 120 days. Key predictors across all models included Karnofsky Performance Status (KPS) score, quality of life (QOL) score, and cough symptoms.

CONCLUSIONS

CoxPH, DT, RF, SVM, and XGBoost models are effective in predicting mortality risk over 60-120 days in patients with advanced lung cancer with low SES. Monitoring KPS, QOL, and cough symptoms is crucial for identifying high-risk patients who may require intensified care. Clinicians should select models tailored to individual patient needs and preferences due to varying prediction accuracies.

REPORTING METHOD

This study was reported in strict compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Global, regional, and national burden of female cancers in women of child-bearing age, 1990-2021: analysis of data from the global burden of disease study 2021

Background

The global status of women's health is underestimated, particularly the burden on women of child-bearing age (WCBA). We aim to investigate the pattern and trend of female cancers among WCBA from 1990 to 2021.

Methods

We retrieved data from the Global Burden of Disease Study (GBD) 2021 on the incidence and disability-adjusted life-years (DALYs) of four major female cancers (breast, cervical, uterine, and ovarian cancer) among WCBA (15-49 years) in 204 countries and territories from 1990 to 2021. Estimated annual percentage changes (EAPC) in the age-standardised incidence and DALY rates of female cancers, by age and socio-demographic index (SDI), were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the correlation between age-standardised rates and SDI.

Findings

In 2021, an estimated 1,013,475 new cases of overall female cancers were reported globally, with a significant increase in age-standardised incidence rate (EAPC 0.16%), and a decrease in age-standardised DALY rate (-0.73%) from 1990 to 2021. Annual increase trends of age-standardised incidence rate were observed in all cancers, except for that in cervical cancer. Contrary, the age-standardised DALY rate decreased in all cancers. Breast and cervical cancers were prevalent among WCBA worldwide, followed by ovarian and uterine cancers, with regional disparities in the burden of four female cancers. In addition, the age-standardised incidence rates of breast, ovarian, and uterine cancers basically showed a consistent upward trend with increasing SDI, while both the age-standardised incidence and DALY rates in cervical cancer exhibited downward trends with SDI. Age-specific rates of female cancers increased with age in 2021, with the most significant changes observed in younger age groups, except for uterine cancer.

Interpretation

The rising global incidence of female cancers, coupled with regional variations in DALYs, underscores the urgent need for innovative prevention and healthcare strategies to mitigate the burden among WCBA worldwide.

Funding

This study was supported by the Science Foundation for Young Scholars of Sichuan Provincial People's Hospital (NO. 2022QN44 and NO. 2022QN18); the Key R&D Projects of Sichuan Provincial Department of Science and Technology (NO. 2023YFS0196); the National Natural Science Foundation of China (No. 82303701).

Socioeconomic disparities and health literacy: Unraveling the impact on diagnostic and cancer care in Uruguay

BACKGROUND

Disparities in the timely diagnosis and care of cancer patients, particularly concerning geographical, racial/ethnic, and economic factors, remain a global health challenge. This study explores the multifaceted interplay between socioeconomic status, health literacy, and specific patient perceptions regarding care access and treatment options that impact cancer care in Uruguay.

METHODS

Using the Cancer Health Literacy Test, Spanish Version (CHLT-30-DKspa), and a highly comprehensive questionnaire, we dissected the factors influencing the pathway to diagnosis and route of cancer care. This was done to identify delays by analyzing diverse socioeconomic and sex subgroups across multiple healthcare settings.

RESULTS

Patients with lower income took longer to get an appointment after showing symptoms (p = 0.02) and longer to get a diagnosis after having an appointment (p = 0.037). Race/ethnicity also had a significant impact on the length of time from symptoms to first appointment (p =0.019), whereas employment status had a significant impact on patients being susceptible to diagnostic delays beyond the advocated 14-day window (p = 0.02). Higher educational levels were positively associated with increased cancer health literacy scores (p = 0.043), revealing the potential to mitigate delays through health literacy-boosting initiatives. Women had significantly higher self-reported symptom duration before seeking an intervention (p = 0.022). We also found many other significant factors effecting treatment delays and cancer health literacy.

CONCLUSIONS

While affirming the global pertinence of socioeconomic- and literacy-focused interventions in enhancing cancer care, the findings underscore a complex, gendered, and perceptually influenced healthcare navigation journey. The results highlight the urgent necessity for strategically crafted, globally relevant interventions that transcend equitable access to integrate literacy, gender sensitivity, and patient-perception alignments in pursuit of optimized global cancer care outcomes.

Disparities in Cancer Incidence across Income Levels in South Korea

BACKGROUND

Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea.

METHODS

This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis.

RESULTS

The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q.

CONCLUSIONS

Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.