Religious Denomination, Religiosity, Religious Attendance, and Cancer Prevention. A Systematic Review

Association Between Risk Factors and Major Cancers: Explainable Machine Learning Approach

Background

Cancer is a life-threatening disease and a leading cause of death worldwide, with an estimated 611,000 deaths and over 2 million new cases in the United States in 2024. The rising incidence of major cancers, including among younger individuals, highlights the need for early screening and monitoring of risk factors to manage and decrease cancer risk.

Objective

This study aimed to leverage explainable machine learning models to identify and analyze the key risk factors associated with breast, colorectal, lung, and prostate cancers. By uncovering significant associations between risk factors and these major cancer types, we sought to enhance the understanding of cancer diagnosis risk profiles. Our goal was to facilitate more precise screening, early detection, and personalized prevention strategies, ultimately contributing to better patient outcomes and promoting health equity.

Methods

Deidentified electronic health record data from Medical Information Mart for Intensive Care (MIMIC)-III was used to identify patients with 4 types of cancer who had longitudinal hospital visits prior to their diagnosis presence. Their records were matched and combined with those of patients without cancer diagnoses using propensity scores based on demographic factors. Three advanced models, penalized logistic regression, random forest, and multilayer perceptron (MLP), were conducted to identify the rank of risk factors for each cancer type, with feature importance analysis for random forest and MLP models. The rank biased overlap was adopted to compare the similarity of ranked risk factors across cancer types.

Results

Our framework evaluated the prediction performance of explainable machine learning models, with the MLP model demonstrating the best performance. It achieved an area under the receiver operating characteristic curve of 0.78 for breast cancer (n=58), 0.76 for colorectal cancer (n=140), 0.84 for lung cancer (n=398), and 0.78 for prostate cancer (n=104), outperforming other baseline models (P<.001). In addition to demographic risk factors, the most prominent nontraditional risk factors overlapped across models and cancer types, including hyperlipidemia (odds ratio [OR] 1.14, 95% CI 1.11-1.17; P<.01), diabetes (OR 1.34, 95% CI 1.29-1.39; P<.01), depressive disorders (OR 1.11, 95% CI 1.06-1.16; P<.01), heart diseases (OR 1.42, 95% CI 1.32-1.52; P<.01), and anemia (OR 1.22, 95% CI 1.14-1.30; P<.01). The similarity analysis indicated the unique risk factor pattern for lung cancer from other cancer types.

Conclusions

The study's findings demonstrated the effectiveness of explainable ML models in assessing nontraditional risk factors for major cancers and highlighted the importance of considering unique risk profiles for different cancer types. Moreover, this research served as a hypothesis-generating foundation, providing preliminary results for future investigation into cancer diagnosis risk analysis and management. Furthermore, expanding collaboration with clinical experts for external validation would be essential to refine model outputs, integrate findings into practice, and enhance their impact on patient care and cancer prevention efforts.

Associations between religiosity/spirituality with insulin resistance and metabolic syndrome in the Midlife in the United States (MIDUS) study

Religiosity and spirituality (R/S) are central aspects to the lives of many people worldwide. Previous research suggests a potentially beneficial relationship between R/S, mostly understood as religious service attendance, and mortality. Though important, this research often fails to account for the complex and multidimensional nature of R/S. Also lacking is an adequate understanding of the physiological mechanisms that may link R/S with mortality and other health outcomes. Insulin resistance and metabolic syndrome, subclinical physiological processes that are influenced by the types of lifestyle factors and psychological factors that R/S addresses, serve as two possible biological mechanisms linking R/S and health outcomes. This study investigated the relations of R/S, defined as service attendance, support from one's religious community, and composite variables comprised of several diverse R/S indicators, in relation to insulin resistance and metabolic syndrome both cross-sectionally and in longitudinal analyses across 8-10 years in the Midlife in the United States (MIDUS) study. Results, controlling for important covariates (demographic factors, self-rated health, chronic conditions, depressive symptoms for all analyses; diabetes status and body mass index for insulin resistance analyses; antihyperlipidemic medications for metabolic syndrome), demonstrated nonsignificant relationships for all measures of R/S and both insulin resistance and metabolic syndrome in both cross-sectional and longitudinal analyses. Integrating these findings into the limited research on physiological mechanisms in the R/S and health relationship suggests that the area lacks consistent findings. Additional studies that use heterogenous, representative samples and further refine the operationalization of R/S are indicated.

Influence of religion and spirituality on head and neck cancer patients and their caregivers: a protocol for a scoping review

INTRODUCTION

Head and neck cancers (HNC) are devastating, thus imposing a negative impact on the appearance of an individual as well as vital activities such as eating, swallowing, speaking, and breathing. Therefore, HNC patients undergo distress, while their caregivers become overburdened. Religion and spirituality can be helpful for patients and their caregivers from diverse cultural backgrounds to cope with cancer. Though well established in palliative care, religion and spirituality are rarely incorporated into usual early oncological care. Despite the availability of heterogeneous literature examining the influence of religion and spirituality on cancer patients, there is notably limited research on this topic across the HNC trajectory. Therefore, this scoping review attempts to answer "What is the influence of religion or spirituality on HNC patients and their caregivers in different contexts?" and will map the evidence on the influence of religion and spirituality on HNC patients and their caregivers in different contexts including geographical areas, cultures, health care systems, and different study settings.

METHODS

This scoping review was formulated using the guidelines of Joanna Briggs Institute (JBI) manual for evidence synthesis: scoping reviews and will be reported confirming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR checklist). A comprehensive search strategy will include Embase, CINAHL, Scopus, and APA PsycINFO. The OPENGREU.EU and Google Scholar will be used as gray literature sources complimented by manual searches. Our eligibility criteria follow the population, concept, and context (PCC) framework. Patients aged ≥ 18 years diagnosed with HNC and their informal, nonpaid caregivers aged > 18 years will be included. The data will be extracted using piloted data extraction form on sociodemographic, disease-related, and treatment-related factors and outcomes, and the data will be analyzed through descriptive statistics and thematic analysis. The results will be narratively synthesized.

CONCLUSIONS/DISCUSSION

This review will aim to explore existing literature and summarize the findings of studies that examine the influence of religion and spirituality among HNC patients and their caregivers and vice versa over a range of physical, psychological, and social outcomes including quality of life. We also aim to identify existing research gaps. The findings of this review would generate evidence to better inform health care providers in countries and cultures in the management of patients diagnosed with HNC in usual oncological care with due consideration to caregivers.

Ikigai and use of preventive healthcare services in Germany

OBJECTIVE

This study examined the association between ikigai (a Japanese concept akin to purpose in life or a rationale for existence) and use of preventive healthcare services.

METHODS

Data were gathered in August and September of 2023 from a quota-based sample of 5000 individuals living in Germany (18 to 74 years). This sampling ensured representation across gender, age groups, and federal states to reflect the adult population of Germany. The recently validated German version of the Ikigai-9 scale (Ikigai-9-G) was used to assess ikigai. Outcomes were regular cancer screenings, flu vaccination, and routine health check-ups. Multiple logistic regressions were used.

RESULTS

Ikigai was associated with higher odds of regular use of preventive healthcare services (regular flu vaccinations: OR = 1.01, 95 % CI: 1.002 to 1.02; regular cancer screenings: OR = 1.01, 95 % CI: 1.004 to 1.02; routine health check-ups: OR = 1.02, 95 % CI: 1.01 to 1.03), adjusting for sociodemographic, lifestyle, and health-related factors. The association between ikigai and preventive healthcare was not moderated by gender, age, or education.

CONCLUSION

Higher ikigai is associated with preventive health measures, independent of key covariates. These findings are consistent with the literature on ikigai and better health-related outcomes and subjective well-being. Ikigai may help point to new ways to counter the low use of preventive services in Germany.

Assessing the Feasibility of a Faith-Based Colorectal Cancer Education and Screening Intervention for Latino Men in Pennsylvania

Introduction: Limited health knowledge, literacy, engagement in preventive health services, participation in health promotion behaviors, and cultural factors place Latino men at high risk for colorectal cancer (CRC). This pilot study aimed to determine the feasibility and acceptability of a faith-based cancer education intervention focusing on Latino men between 45 and 74 years old. Methods: This pilot study used a single group pre- and post-intervention research design to compare changes in knowledge, perceived benefit of screening, perceived susceptibility and severity of CRC, and the completion of CRC screening after the intervention. Results: In this study, Latino men were willing to participate in a CRC educational intervention supported by a faith-based institution. The participants had limited knowledge about CRC, yet most recognized that screening is beneficial and that getting CRC is serious. Sixty percent of the participants completed the fecal immunochemical screening test, which showed that the intervention impacted the screening uptake among this group. Conclusion: The findings of this study support the further development of faith-based interventions focusing on Latino men.

The Association Between Religiosity, Spirituality and Colorectal Cancer Screening: A Longitudinal Analysis of Alberta's Tomorrow Project in Canada

We explored longitudinal associations between religion/spirituality (R/S) Salience and R/S Attendance, and colorectal cancer screening, among adults aged ≥ 50 years in Alberta, Canada. R/S Salience was not statistically significantly associated with colorectal cancer screening (adjusted odds ratio [aOR]: 1.06, 95% confidence interval [CI] 0.88-1.28). Conversely, R/S Attendance was statistically significantly associated with higher odds of colorectal cancer screening: the aOR was 1.28 (95% CI 1.02-1.59) for participants attending services at least once a month and 1.31 (95% CI 1.01-1.69) for participants attending between one and four times yearly, compared to participants who never attended. Researchers should explore the possibility of delivering colorectal cancer screening programs in R/S settings.

The link between spirituality and longevity

We are facing an inverted demographic pyramid with continuously growing aged populations around the world. However, the advances that prolong physical life not always contemplate its psychological and social dimensions. Longevity is a complex outcome influenced by a wide range of factors, including genetics, lifestyle choices, access to healthcare, socio-economic conditions, and other environmental factors. These factors have been generally considered in the compelling research that seeks the determinants of longevity, particularly those concerning personal lifestyle choices, socioeconomic conditions, and molecular mechanisms proposed to mediate these effects. Nonetheless, fundamental aspects that can affect health and well-being, such as spirituality and religiosity, have been somehow left aside despite numerous epidemiological studies showing that higher levels of spirituality/religiosity are associated with lower risk of mortality, even after adjusting for relevant confounders. Because spirituality/religiosity are dimensions of great value for patients, overlooking them can leave them with feelings of neglect and lack of connection with the health system and with the clinicians in charge of their care. Integrating spirituality and religiosity assessment and intervention programs into clinical care can help each person obtain better and complete well-being and also allowing clinicians to achieve the highest standards of health with holistic, person-centered care. The present narrative review aims to explore the available evidence of a relationship between spirituality/religiosity and longevity and discusses the possible mechanisms that can help explain such relationship.

Impact of socioeconomic position on the utilization of rehabilitation services among the Chinese older adults disabled by injury

Aim

This study aimed to explore the utilization of rehabilitation services and associated socioeconomic position (SEP) factors among Chinese older adults disabled by injury.

Methods

Data from the second China National Sample Survey on Disability (CSSD) were used in this study. Chi-square test was used to analyze the significant differences between groups, and binary logistic regression model was used to calculate the odds ratios and 95% confidence intervals for socioeconomic factors associated with utilization of rehabilitation services among Chinese older adults disabled by injury.

Results

Among the older adults disabled by injury in the CSSD, the gap between demand and utilization of medical treatment, assistive devices and rehabilitation training were around 38, 75, and 64%, respectively. This study revealed two relationship patterns ("high-low-high" and "low-high-low") among SEP, prevalence of injury-caused disability and odds of utilization of rehabilitation services among the Chinese older adults disabled by injury, that is, the older adult with higher SEP have a lower prevalence of injury-caused disability, but a higher odds of utilization of rehabilitation services; conversely, the older adults with lower SEP have a relatively higher prevalence but a lower odds of utilization of rehabilitation services.

Conclusion

There is a large gap between the high demand and low utilization of rehabilitation services among the Chinese older adults disabled by injury, especially for those living in the central or western regions or rural areas, without insurance or disability certificate, having the annual household per capita income lower than the national average or lower educational level. Strategies to improve the disability manage system, to strengthen the chain of "information discovery-information transmission-rehabilitation services supply-continuous health monitoring and management" for the older adults disabled by injury are warranted. In view of the poor and illiterate groups among the disabled older adults, to enhance medical aids and popularize the scientific information to compensate for the lack of affordability and awareness of rehabilitation services utilization is essential. In addition, it is necessary to further expand the coverage and improve the payment system of medical insurance for rehabilitation services.