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Graboyes EM, Chappell M, Duckett KA, Sterba K, Halbert CH, Hill EG, Chera B, McCay J, Puram SV, Ramadan S, Sandulache VC, Kahmke R, Nussenbaum B, Alberg AJ, Paskett ED, Calhoun E. Patient Navigation for Timely, Guideline-Adherent Adjuvant Therapy for Head and Neck Cancer: A National Landscape Analysis. J Natl Compr Canc Netw 2023; 21:1251-1259.e5. [PMID: 38081134 PMCID: PMC10846494 DOI: 10.6004/jnccn.2023.7061] [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: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Aligned with the NCCN Clinical Practice Guidelines in Oncology for Head and Neck Cancers, in November 2021 the Commission on Cancer approved initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery for head and neck cancer (HNC) as its first and only HNC quality metric. Unfortunately, >50% of patients do not commence PORT within 6 weeks, and delays disproportionately burden racial and ethnic minority groups. Although patient navigation (PN) is a potential strategy to improve the delivery of timely, equitable, guideline-adherent PORT, the national landscape of PN for this aspect of care is unknown. MATERIALS AND METHODS From September through November 2022, we conducted a survey of health care organizations that participate in the American Cancer Society National Navigation Roundtable to understand the scope of PN for delivering timely, guideline-adherent PORT for patients with HNC. RESULTS Of the 94 institutions that completed the survey, 89.4% (n=84) reported that at least part of their practice was dedicated to navigating patients with HNC. Sixty-eight percent of the institutions who reported navigating patients with HNC along the continuum (56/83) reported helping them begin PORT. One-third of HNC navigators (32.5%; 27/83) reported tracking the metric for time-to-PORT at their facility. When estimating the timeframe in which the NCCN and Commission on Cancer guidelines recommend commencing PORT, 44.0% (37/84) of HNC navigators correctly stated ≤6 weeks; 71.4% (60/84) reported that they did not know the frequency of delays starting PORT among patients with HNC nationally, and 63.1% (53/84) did not know the frequency of delays at their institution. CONCLUSIONS In this national landscape survey, we identified that PN is already widely used in clinical practice to help patients with HNC start timely, guideline-adherent PORT. To enhance and scale PN within this area and improve the quality and equity of HNC care delivery, organizations could focus on providing better education and support for their navigators as well as specialization in HNC.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Chappell
- American Cancer Society National Navigation Roundtable, Cincinnati, Ohio
| | - Kelsey A. Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Bhishamjit Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Sidharth V. Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Salma Ramadan
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Brian Nussenbaum
- American Board of Otolaryngology - Head and Neck Surgery, Houston, Texas
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Electra D. Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
- Division of Cancer Prevention Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Elizabeth Calhoun
- Department of Population Health, University of Illinois Chicago, Chicago, Illinois
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Molina Y, Kao SY, Bergeron NQ, Strayhorn-Carter SM, Strahan DC, Asche C, Watson KS, Khanna AS, Hempstead B, Fitzpatrick V, Calhoun EA, McDougall J. The Integration of Value Assessment and Social Network Methods for Breast Health Navigation Among African Americans. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1494-1502. [PMID: 37301367 PMCID: PMC10530024 DOI: 10.1016/j.jval.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 05/10/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES A major strategy to reduce the impact of breast cancer (BC) among African Americans (AA) is patient navigation, defined here as individualized assistance for reducing barriers to healthcare use. The primary focus of this study was to estimate the added value of incorporating breast health promotion by navigated participants and the subsequent BC screenings that network members may obtain. METHODS In this study, we compared the cost-effectiveness of navigation across 2 scenarios. First, we examine the effect of navigation on AA participants (scenario 1). Second, we examine the effect of navigation on AA participants and their networks (scenario 2). We leverage data from multiple studies in South Chicago. Our primary outcome (BC screening) is intermediate, given limited available quantitative data on the long-term benefits of BC screening for AA populations. RESULTS When considering participant effects alone (scenario 1), the incremental cost-effectiveness ratio was $3845 per additional screening mammogram. When including participant and network effects (scenario 2), the incremental cost-effectiveness ratio was $1098 per additional screening mammogram. CONCLUSION Our findings suggest that inclusion of network effects can contribute to a more precise, comprehensive assessment of interventions for underserved communities.
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Affiliation(s)
- Yamilé Molina
- University of Illinois at Chicago, Chicago, IL, USA.
| | - Szu-Yu Kao
- University of Minnesota, Minneapolis, MN, USA
| | | | | | | | - Carl Asche
- University of Illinois at Chicago, Chicago, IL, USA; Huntsman Cancer Institute, Salt Lake City, UT, USA
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Jones T, Wisdom-Chambers K, Freeman K, Edwards K. Barriers to Mammography Screening among Black Women at a Community Health Center in South Florida, USA. MEDICAL RESEARCH ARCHIVES 2023; 11:10.18103/mra.v11i4.3814. [PMID: 37475892 PMCID: PMC10358292 DOI: 10.18103/mra.v11i4.3814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Background In the United States (US), Black/African American women suffer disproportionately from breast cancer health disparities with a 40% higher death rate compared to White women. Mammography screening is considered a critical tool in mitigating disparities, yet Black women experience barriers to screening and are more likely to be diagnosed with advanced-stage breast cancer. The purpose of this study was to assess the relative frequency of mammography screening and to examine perceived and actual barriers to screening among women who receive care in our nurse-led community health center. Methods We conducted a survey examining frequency of mammography screening and beliefs about breast cancer including perceived susceptibility, perceived benefits, and perceived barriers to mammography screening, guided by the Champion Health Belief Model. Results A total of 30 Black/African American women completed the survey. The mean age of the participants was 54.3 years ± 9.17 (SD); 43.3% had a high school education or less; 50% had incomes below $60,000 per year; 26.7% were uninsured; 10% were on Medicaid; and only 50% were working full-time. We found that only half of the participants reported having annual mammograms 16 (53.3%), 1 (3.3%) every 6 months, 8 (26.6%) every 2-3 years, and 5 (16.7%) never had a mammogram in their lifetime. Frequently cited barriers included: 'getting a mammogram would be inconvenient for me'; 'getting a mammogram could cause breast cancer'; 'the treatment I would get for breast cancer would be worse than the cancer itself'; 'being treated for breast cancer would cause me a lot of problems'; 'other health problems would keep me from having a mammogram'; concern about pain with having a mammogram would keep me from having one; and not being able to afford a mammogram would keep me from having one'. Having no health insurance was also a barrier. Conclusion This study found suboptimal utilization of annual screening mammograms among low-income Black women at a community health center in Florida and women reported several barriers. Given the high mortality rate of breast cancer among Black/African American women, we have integrated a Patient Navigator in our health system to reduce barriers to breast cancer screening, follow-up care, and to facilitate timely access to treatment, thus ultimately reducing breast cancer health disparities and promoting health equity.
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Affiliation(s)
- Tarsha Jones
- Professor John F. Wymer, Jr. Endowed Distinguished Professor CEO FAU/NCHA Community Health Center. Member, National Advisory Committee, American Nurses Association/Substance Abuse and Mental Health Services Administration Minority Fellowship Program, Florida Atlantic University
| | - Karen Wisdom-Chambers
- Professor John F. Wymer, Jr. Endowed Distinguished Professor CEO FAU/NCHA Community Health Center. Member, National Advisory Committee, American Nurses Association/Substance Abuse and Mental Health Services Administration Minority Fellowship Program, Florida Atlantic University
| | - Katherine Freeman
- Professor John F. Wymer, Jr. Endowed Distinguished Professor CEO FAU/NCHA Community Health Center. Member, National Advisory Committee, American Nurses Association/Substance Abuse and Mental Health Services Administration Minority Fellowship Program, Florida Atlantic University
| | - Karethy Edwards
- Professor John F. Wymer, Jr. Endowed Distinguished Professor CEO FAU/NCHA Community Health Center. Member, National Advisory Committee, American Nurses Association/Substance Abuse and Mental Health Services Administration Minority Fellowship Program, Florida Atlantic University
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Heymann O, Odum T, Norris AH, Bessett D. Selecting an Abortion Clinic: The Role of Social Myths and Risk Perception in Seeking Abortion Care. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:90-104. [PMID: 34605701 DOI: 10.1177/00221465211044413] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Recent shifts in the abortion provision landscape have generated increased concern about how people find abortion care as regulations make abortion less accessible and clinics close. Few studies examine the reasons that people select particular facilities in such constrained contexts. Drawing from interviews with 41 Ohio residents, we find that people's clinic selections are influenced by the risks they associate with abortion care. Participants' strategies for selecting an abortion clinic included: drawing on previous experience with clinics, consulting others online, discerning reputation through name recognition and clinic type, and considering location, especially perceptions about place (privacy, legality, safety). We argue that social myths inform the risks people anticipate when seeking health care facilities, shaping care seeking in ways that are both abortion-specific and more general. These findings can also inform research in other health care contexts where patients increasingly find their options constrained by rising costs, consolidation, and facility closure.
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Affiliation(s)
| | - Tamika Odum
- University of Cincinnati, Blue Ash, Cincinnati, OH, USA
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Henderson V, Strayhorn SM, Bergeron NQ, Strahan DC, Ganschow PS, Khanna AS, Watson K, Hoskins K, Molina Y. Healthcare Predictors of Information Dissemination About Genetic Risks. Cancer Control 2022; 29:10732748221104666. [PMID: 35658635 PMCID: PMC9174561 DOI: 10.1177/10732748221104666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives Despite the benefits of genetic counseling and testing (GCT), utilization is
particularly low among African American (AA) women who exhibit breast cancer
features that are common in BRCA-associated cancer. Underutilization is
especially problematic for AA women who are more likely to die from breast
cancer than women from any other race or ethnicity. Due to medical mistrust,
fear, and stigma that can be associated with genetic services among
racial/ethnic minorities, reliance on trusted social networks may be an
impactful strategy to increase dissemination of knowledge about hereditary
cancer risk. Informed by the social cognitive theory, the purpose of this
study is to determine: 1) which AA patients diagnosed with breast cancer and
with identified hereditary risk are sharing information about hereditary
risk with their networks; 2) the nature of the information dissemination;
and 3) if personal GCT experiences is associated with dissemination of
information about hereditary risk. Methods Among consented participants (n = 100) that completed an interview
administered using a 202-item questionnaire consisting of open- and
closed-ended questions, 62 patients were identified to be at higher risk for
breast cancer. Descriptive statistics, bivariable chi-square, Pearson’s
exact tests, and regression analyses were conducted to examine differences
in characteristics between high-risk participants who disseminated
hereditary risk information and participants who did not. Results Among high-risk participants, 25 (40%) indicated they had disseminated
information about hereditary risk to at least one member in their
family/friend network and 37 (60%) had not. Receipt of both provider
recommendations and receipt of GCT services was associated with greater odds
of disseminating information about hereditary risk with networks, OR = 4.53,
95%CI [1.33, 15.50], p = .02. Conclusion Interventions that increase self-efficacy gained through additional
personalized knowledge and experience gained through provider
recommendations and by undergoing GCT may facilitate information
dissemination among social/familial networks.
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Affiliation(s)
- Vida Henderson
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA, USA.,14681Community Health Sciences Division, University of Illinois Chicago, Chicago, IL, USA
| | - Shaila M Strayhorn
- 14621School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Nyahne Q Bergeron
- 14681Community Health Sciences Division, University of Illinois Chicago, Chicago, IL, USA
| | - Desmona C Strahan
- 14681Community Health Sciences Division, University of Illinois Chicago, Chicago, IL, USA
| | - Pamela S Ganschow
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois Chicago, Chicago, IL, USA
| | - Aditya S Khanna
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Karriem Watson
- All of Us Program, National Institutes of Health, Bethesda, MD, USA
| | - Kent Hoskins
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois Chicago, Chicago, IL, USA
| | - Yamile Molina
- 14681Community Health Sciences Division, University of Illinois Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois Chicago, Chicago, IL, USA
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Navigated African American breast cancer patients as incidental change agents in their family/friend networks. Support Care Cancer 2021; 30:2487-2496. [PMID: 34783907 DOI: 10.1007/s00520-021-06674-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patient navigation is an increasingly widespread intervention to address the persistent, severe, and disproportionate breast cancer (BC) burden that African Americans (AA) face. Navigation may have more widespread effects than previously estimated due to patient-driven diffusion of BC information. METHODS This pilot study examined the network effects of a randomized controlled trial via recruitment of navigated and non-navigated AA BC patients as well as their network members. We estimated study arm differences in patient BC promotion (i.e., number of individuals to whom BC patients promote BC screening) and network BC screening (i.e., % BC screening among network members). RESULTS Among our sample of 100 AA BC patients, navigated patients promoted BC screening to more individuals than non-navigated patients. BC patients were more likely to promote BC screening to children and individuals with whom they communicated more frequently. Some models further suggested more network BC screening among "navigated" network members relative to "non-navigated" network members. CONCLUSIONS Navigated AA patients promoted BC screening more widely throughout their networks than non-navigated AA BC patients. There were also suggestive findings regarding increased BC screening among their network members. Our pilot study highlights the potential for social network analysis to improve the precision of intervention effect estimates and to inform future innovations (e.g., integrating navigation and network-based interventions) with multilevel effects on cancer health disparities.
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Molina Y, Khanna A, Watson KS, Villines D, Bergeron N, Strayhorn S, Strahan D, Skwara A, Cronin M, Mohan P, Walton S, Wang T, Schneider JA, Calhoun EA. Leveraging system sciences methods in clinical trial evaluation: An example concerning African American women diagnosed with breast cancer via the Patient Navigation in Medically Underserved Areas study. Contemp Clin Trials Commun 2019; 15:100411. [PMID: 31406947 PMCID: PMC6682374 DOI: 10.1016/j.conctc.2019.100411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/25/2023] Open
Abstract
Background Systems science methodologies offer a promising assessment approach for clinical trials by: 1) providing an in-silico laboratory to conduct investigations where purely empirical research may be infeasible or unethical; and, 2) offering a more precise measurement of intervention benefits across individual, network, and population levels. We propose to assess the potential of systems sciences methodologies by quantifying the spillover effects of randomized controlled trial via empirical social network analysis and agent-based models (ABM). Design/methods We will evaluate the effects of the Patient Navigation in Medically Underserved Areas (PNMUA) study on adult African American participants diagnosed with breast cancer and their networks through social network analysis and agent-based modeling. First, we will survey 100 original trial participants (50 navigated, 50 non-navigated) and 150 of members of their social networks (75 from navigated, 75 non-navigated) to assess if navigation results in: 1) greater dissemination of breast health information and breast healthcare utilization throughout the trial participants’ networks; and, 2) lower incremental costs, when incorporating navigation effects on trial participants and network members. Second, we will compare cost-effectiveness models, using a provider perspective, incorporating effects on trial participants versus trial participants and network members. Third, we will develop an ABM platform, parameterized using published data sources and PNMUA data, to examine if navigation increases the proportion of early stage breast cancer diagnoses. Discussion Our study results will provide promising venues for leveraging systems science methodologies in clinical trial evaluation.
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Affiliation(s)
- Yamilé Molina
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
| | - Aditya Khanna
- The University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Karriem S Watson
- University of Illinois Cancer Center, 1801 W Taylor St #1E, Chicago, IL, 60612, USA.,School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
| | - Dana Villines
- Advocate Health Care Research Institute, Chicago, IL, USA
| | - Nyahne Bergeron
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
| | - Shaila Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA
| | - Desmona Strahan
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA
| | - Abigail Skwara
- The University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Michael Cronin
- The University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Prashanthinie Mohan
- College of Medicine, University of Arizona, 550 East Van Buren Street, Phoenix, AZ, 85004, USA
| | - Surrey Walton
- College of Pharmacy, University of Illinois at Chicago, 833 West Wood, Chicago, IL, 60612, USA
| | - Tianxiu Wang
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, USA
| | - John A Schneider
- The University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Elizabeth A Calhoun
- College of Medicine, University of Arizona, 550 East Van Buren Street, Phoenix, AZ, 85004, USA
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Brown J, Kaufman RE, Ariail M, Williams DL. Assessing patient navigation as a tool to address equity in cancer early detection. Transl Cancer Res 2019; 8:S421-S430. [PMID: 35117118 PMCID: PMC8799019 DOI: 10.21037/tcr.2019.05.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/22/2019] [Indexed: 11/26/2022]
Abstract
Background The Louisiana Breast and Cervical Health Program (LBCHP) provides breast and cervical cancer screenings at no cost to about 5,000 low-income women per year. LBCHP was designed to increase access to cancer screenings for low-income women, a traditionally underserved population. A main program component is the provision of patient navigation services. Patient navigation provides extra layers of patient-centered education and resources to assist with screening completion. Both rural and racial/ethnic minority populations are underserved and have benefited from patient navigation. The purpose of this study was to establish estimates of LBCHP’s eligible population and to measure the effect of patient navigation in reducing racial/ethnic and geographic (e.g., rural) inequities in cancer early detection. Methods This study analyzed program data from patients who received navigation services resulting in cervical and breast cancer screenings between July 01, 2016 and June 30, 2018. We used the combination of U.S. Census Bureau’s Small Area Health Insurance Estimates 2016 and the American Community Survey 2017 to calculate the number of eligible women by race/ethnicity and by parish (county). We used the 2010 Census to estimate the distribution of the rural population by city and parish. Using patient addresses, residences were categorized into urban, suburban and rural. Results The population of women ages 21–64 years in Louisiana is 1.3 million and almost half (46.7%) live at or under 250% of the federal poverty level (FPL). The poverty rate is much higher among LBCHP’s racial/ethnic minorities: 65.1% among Blacks and 58.5% among Latinx as compared to 35.5% among Whites. To be racially/ethnically equitable, LBCHP would aim to have the following client distribution: at least 47% Black and 5% Latinx. The population LBCHP served was 47% Black and 18% Latinx. While 27% of Louisiana is rural, only 17% of LBCHP’s women served are from rural areas. In contrast, 61% of the state is urban, while 72% of LBCHP’s women served live in urban areas. LBCHP’s clients had excellent follow-up rates after abnormal screening test results with well over 95% of all racial/ethnic groups having completed follow-up. Latinxs had a higher percentage of abnormal results than Blacks and Whites. Conclusions This study showed that LBCHP is achieving racial/ethnic equity in the client population that is served through patient navigation with LBCHP’s largest reach among the Latinx population. In addition, once clients receive screening, they have excellent follow-up rates for any abnormalities. Because LBCHP’s program goals include serving a high number of women, an unintended consequence is that LBCHP’s rural population is underserved.
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Affiliation(s)
- Janet Brown
- Department of Behavioral and Community Health Sciences, Louisiana State University Health New Orleans School of Public Health, New Orleans, LA, USA
| | - Randi E Kaufman
- Department of Health Policy and Systems Management, Louisiana State University Health New Orleans School of Public Health, New Orleans, LA, USA
| | - Molly Ariail
- Department of Behavioral and Community Health Sciences, Louisiana State University Health New Orleans School of Public Health, New Orleans, LA, USA
| | - Donna L Williams
- Department of Behavioral and Community Health Sciences, Louisiana State University Health New Orleans School of Public Health, New Orleans, LA, USA
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Saini G, Ogden A, McCullough LE, Torres M, Rida P, Aneja R. Disadvantaged neighborhoods and racial disparity in breast cancer outcomes: the biological link. Cancer Causes Control 2019; 30:677-686. [PMID: 31111277 PMCID: PMC7043809 DOI: 10.1007/s10552-019-01180-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
Neighborhoods encompass complex environments comprised of unique economic, physical, and social characteristics that have a profound impact on the residing individual's health and, collectively, on the community's wellbeing. Neighborhood disadvantage (ND) is one of several factors that prominently contributes to racial breast cancer (BC) health disparities in American women. African American (AA) women develop more aggressive breast cancer features, such as triple-negative receptor status and more advanced histologic grade and tumor stage, and suffer worse clinical outcomes than European American (EA) women. While the adverse effects of neighborhood disadvantage on health, including increased risk of cancer and decreased longevity, have recently come into focus, the specific molecular mechanisms by which neighborhood disadvantage increases BC risk and worsens BC outcomes (survivorship, recurrence, mortality) are not fully elucidated. This review illuminates the probable biological links between neighborhood disadvantage and predominantly BC risk, with an emphasis on stress reactivity and inflammation, epigenetics and telomere length in response to adverse neighborhood conditions.
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Affiliation(s)
- Geetanjali Saini
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Angela Ogden
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Mylin Torres
- Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Padmashree Rida
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA.
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Kim SJ, Glassgow AE, Watson KS, Molina Y, Calhoun EA. Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis. Cancer 2018; 124:4350-4357. [PMID: 30246241 DOI: 10.1002/cncr.31636] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/07/2018] [Accepted: 06/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women. METHODS Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow-up screening mammogram was compared between women who identified ≥1 barriers and those who did not. RESULTS Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers. CONCLUSIONS Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial.
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Affiliation(s)
- Sage J Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Anne Elizabeth Glassgow
- College of Medicine, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | | | - Yamile Molina
- Division of Community Health Science, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Elizabeth A Calhoun
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, Arizona
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Breast Cancer Disparities Among Women in Underserved Communities in the USA. CURRENT BREAST CANCER REPORTS 2018; 10:131-141. [PMID: 31501690 DOI: 10.1007/s12609-018-0277-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of Review Breast cancer disparities that exist between high-income countries (HIC) and low- and middle-income countries (LMICs) are also reflected within population subgroups throughout the United States (US). Here we examine three case studies of US populations "left behind" in breast cancer outcomes/equity. Recent Findings African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State all experience a myriad of factors that contribute to lower rates of breast cancer detection and appropriate treatment as well as poorer survival. These factors, related to the social determinants of health, including geographic isolation, lack of availability of care, and personal constraints, can be addressed with interventions at multiple levels. Summary Although HICs have reduced mortality of breast cancer compared to LMICs, there remain inequities in the US healthcare system. Concerted efforts are needed to ensure that all women have access to equitable screening, detection, treatment, and survivorship resources.
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Glassgow AE, Molina Y, Kim S, Campbell RT, Darnell J, Calhoun EA. A Comparison of Different Intensities of Patient Navigation After Abnormal Mammography. Health Promot Pract 2018; 20:914-921. [PMID: 29907079 DOI: 10.1177/1524839918782168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Patient navigation is a practice strategy to address barriers to timely diagnosis and treatment of cancer. The aim of this study was to examine the effectiveness of varying intensities of patient navigation and timely diagnostic resolution after abnormal mammography. Method. This is a secondary analysis of a subset of women with an abnormal screening or diagnostic mammogram who participated in the "patient navigation in medically underserved areas" 5-year randomized trial. We compared timely diagnostic resolution in women assigned to different intensities of patient navigation including, full navigation intervention, no contact with navigators, or limited contact with navigators. Results. The sample included 1,725 women with abnormal mammogram results. Women who interacted with patient navigators had significantly fewer days to diagnostic resolution after abnormal mammography compared with women who did not interact with patient navigators. Discussion. Results from our study suggest that even limited contact with navigators encourages women to seek more timely diagnostic resolution after an abnormal mammogram, which may offer a low-cost practice strategy to improve timely diagnosis for disadvantaged and underserved women.
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Affiliation(s)
| | | | - Sage Kim
- University of Illinois at Chicago, Chicago, IL, USA
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