1
|
Belon AP, McKenzie E, Teare G, Nykiforuk CIJ, Nieuwendyk L, Kim MO, Lee B, Adhikari K. Effective strategies for Fecal Immunochemical Tests (FIT) programs to improve colorectal cancer screening uptake among populations with limited access to the healthcare system: a rapid review. BMC Health Serv Res 2024; 24:128. [PMID: 38263112 PMCID: PMC10807065 DOI: 10.1186/s12913-024-10573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access. METHODS We used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates of FIT screening, and participation rates in follow-up colonoscopy after FIT positive results). For evidence synthesis, deductive and inductive thematic analysis was conducted. The findings were also classified using the Cochrane Methods Equity PROGRESS-PLUS framework. The quality of the included studies was assessed. RESULTS Findings from the 25 included primary studies were organized into three intervention design-focused themes. Delivery of culturally-tailored programs (e.g., use of language and interpretive services) were effective in increasing CRC screening. Regarding the method of delivery for FIT, specific strategies combined with mail-out programs (e.g., motivational screening letter) or in-person delivery (e.g., demonstration of FIT specimen collection procedure) enhanced the success of FIT programs. The follow-up reminder theme (e.g., spaced out and live reminders) were generally effective. Additionally, we found evidence of the social determinants of health affecting FIT uptake (e.g., place of residence, race/ethnicity/culture/language, gender and/or sex). CONCLUSIONS Findings from this rapid review suggest multicomponent interventions combined with tailored strategies addressing the diverse, unique needs and priorities of the population with no regular healthcare provider or limited access to the healthcare system may be more effective in increasing FIT screening. Decision-makers and practitioners should consider equity and social factors when developing resources and coordinating efforts in the delivery and implementation of FIT screening strategies.
Collapse
Affiliation(s)
- Ana Paula Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Emily McKenzie
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada
- Health Evidence and Impact, Alberta Health Services, Calgary, Canada
| | - Gary Teare
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Candace I J Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Laura Nieuwendyk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Minji Olivia Kim
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Bernice Lee
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Kamala Adhikari
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada.
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada.
| |
Collapse
|
2
|
Jessiman-Perreault G, Law J, Adhikari K, Machado AA, Moysey B, Xu L, Yang H, Scott LKA, Teare G, Li A. Geospatial analysis and participant characteristics associated with colorectal cancer screening participation in Alberta, Canada: a population-based cross-sectional study. BMC Health Serv Res 2023; 23:1454. [PMID: 38129826 PMCID: PMC10740253 DOI: 10.1186/s12913-023-10486-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of death in Canada and early detection can prevent deaths through screening. However, CRC screening in Alberta, Canada remains suboptimal and varies by sociodemographic and health system characteristics, as well as geographic location. This study aimed to further the understanding of these participant and health system characteristics associated with CRC screening in Alberta and identify clusters of regions with higher rates of overdue or unscreened individuals. METHODS We included Albertans aged 52 to 74 as of December 31, 2019 (index date) and we used data from administrative health data sources and linked to the Alberta Colorectal Cancer Screening Program database to determine colorectal cancer screening rates. We used multivariable multinomial logistic regression analysis to investigate the relationship between sociodemographic, health system characteristics and participation in CRC screening. We used optimized Getis-Ord Gi* hot-spot analysis to identify hot and cold-spots in overdue for and no record of CRC screening. RESULTS We included 919,939 Albertans, of which 65% were currently up to date on their CRC screening, 21% were overdue, and 14% had no record of CRC screening. Compared to Albertans who were currently up to date, those who were in older age groups, those without a usual provider of care, those who were health system non-users, and those living in more deprived areas were more likely to have no record of screening. Areas with high number of Albertans with no record of screening were concentrated in the North and Central zones. CONCLUSIONS Our study showed important variation in colorectal cancer screening participation across sociodemographic, health system and geographical characteristics and identified areas with higher proportions of individuals who have no record of screening or are under-screened in Alberta, Canada.
Collapse
Affiliation(s)
- Geneviève Jessiman-Perreault
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Jessica Law
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Kamala Adhikari
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada.
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Amanda Alberga Machado
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Barbara Moysey
- Screening Programs, Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Linan Xu
- Screening Programs, Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Huiming Yang
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Screening Programs, Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Lisa K Allen Scott
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Oncology, University of Calgary, 1331 29th Street NW, Calgary, AB, T2N 4N2, Canada
| | - Gary Teare
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Alvin Li
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| |
Collapse
|
3
|
Pichardo MS, Ferrucci LM, Molina Y, Esserman DA, Irwin ML. Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review. Cancer Epidemiol Biomarkers Prev 2023; 32:1498-1507. [PMID: 37650844 PMCID: PMC10872641 DOI: 10.1158/1055-9965.epi-22-1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/02/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.
Collapse
Affiliation(s)
- Margaret S. Pichardo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA 19104
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| | - Yamile Molina
- School of Public Health, University of Illinois Chicago and Cancer Center University of Illinois Chicago, 60607
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06520
- Yale Cancer Center, New Haven, CT 06520
| |
Collapse
|
4
|
McClellan SP, Canchola AJ, Potter MB, Gomez SL, Somsouk M. Neighborhood socioeconomic status and the effectiveness of colorectal cancer screening outreach with mailed fecal immunochemical tests within a safety net healthcare system in San Francisco, CA: A subgroup analysis of a randomized controlled trial. Prev Med 2023; 167:107388. [PMID: 36528113 DOI: 10.1016/j.ypmed.2022.107388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Neighborhood context shapes opportunities and barriers for residents to access healthcare and cancer screening. Neighborhood socioeconomic status (nSES) is associated with disparities in colorectal cancer (CRC) screening, but the extent to which the effectiveness of specific screening interventions vary by nSES has not been studied. The original trial conducted in San Francisco, CA from 2016 to 2017 randomly assigned patients eligible for CRC screening either to a multicomponent intervention including advanced notification, mailed fecal immunochemical test (FIT) kits and reminders or to a control group receiving usual care. For the nSES analysis addresses for 9699 patients were geocoded and stratified by city-wide nSES quintile (Q1 lowest, Q5 highest) using an established index at the census tract level. Compared to usual care, the outreach intervention improved FIT test completion at one year (58.7% vs 38.4%; OR 2.32 [2.14, 2.52]) but its effectiveness did not vary substantially by nSES quintile (adjusted OR Q1 2.64 [2.30, 3.04]; Q2 2.43 [2.04, 2.90]; Q3 2.31 [1.84, 2.89]; Q4 2.47 [1.86, 3.28]; Q5 2.64 [1.83, 3.81]; Wald test for interaction p = 0.87). The implementation of mailed FIT outreach has the potential to increase CRC screening completion without leading to disparities in screening related to nSES (ClinicalTrials.gov NCT02613260).
Collapse
Affiliation(s)
- Sean P McClellan
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Ma Somsouk
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA; Division of Gastroenterology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| |
Collapse
|
5
|
Masica AL, Velasco F, Nelson TL, Medford RJ, Hughes AE, Pandey A, Peterson ED, Lehmann CU. The Texas Health Resources Clinical Scholars Program: Learning healthcare system workforce development through embedded translational research. Learn Health Syst 2022; 6:e10332. [PMID: 36263262 PMCID: PMC9576247 DOI: 10.1002/lrh2.10332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Texas Health Resources (THR), a large, nonprofit health care system based in the Dallas-Fort Worth area, has collaborated with the University of Texas Southwestern Medical Center (UTSW) to develop and operate a unique, integrated approach for Learning Health System (LHS) workforce development. This training model centers on academic health system faculty members conducting later-stage translational research within a partnering regional care delivery organization. Methods The THR Clinical Scholars Program engages early career UTSW faculty members to conduct studies that are likely to have an impact on care delivery at the health system level. Interested candidates submit formal applications to the program. A joint committee comprised of senior research faculty from UTSW and THR clinical leadership reviews proposals with a focus on the shared LHS needs of both institutions-developing high quality research output that can be applied to enhance care delivery. A key prioritization criterion for funding is the degree to which the research addresses a question relevant to THR as a high-volume network with multiple channels for consumers to access care. The program emphasis is on supporting embedded research initiatives using health system data to generate knowledge that will improve the quality and efficiency of care for the patient populations served by the participant organizations. Results We discuss specific strategic and tactical components of the THR Clinical Scholars Program including an overview of the academic affiliation agreement between the collaborating organizations, criteria for successful program applications, data sharing, and funding. We also share project summaries from selected clinical scholars as examples of the LHS research done in the program to date. Conclusion This experience report provides an implementation framework for other academic health systems interested in adopting similar LHS workforce training models with community partners.
Collapse
Affiliation(s)
| | | | | | - Richard J. Medford
- Division of Infectious Diseases, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA,Clinical Informatics CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Amy E. Hughes
- Department of Population and Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Eric D. Peterson
- Division of Cardiology, Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Christoph U. Lehmann
- Clinical Informatics CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA,Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| |
Collapse
|
6
|
Abstract
IMPORTANCE Area-level factors have been identified as important social determinants of health (SDoH) that impact many health-related outcomes. Less is known about how the social vulnerability index (SVI), as a scalable composite score, can multidimensionally explain the population-based cancer screening program uptake at a county level. OBJECTIVE To examine the geographic variation of US Preventive Services Task Force (USPSTF)-recommended breast, cervical, and colorectal cancer screening rates and the association between county-level SVI and the 3 screening rates. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study used county-level information from the Centers for Disease Control and Prevention's PLACES and SVI data sets from 2018 for 3141 US counties. Analyses were conducted from October 2021 to February 2022. EXPOSURES Social vulnerability index score categorized in quintiles. MAIN OUTCOMES AND MEASURES The main outcome was county-level rates of USPSTF guideline-concordant, up-to-date breast, cervical, and colorectal screenings. Odds ratios were calculated for each cancer screening by SVI quintile as unadjusted (only accounting for eligible population per county) or adjusted for urban-rural status, percentage of uninsured adults, and primary care physician rate per 100 000 residents. RESULTS Across 3141 counties, county-level cancer screening rates showed regional disparities ranging from 54.0% to 81.8% for breast cancer screening, from 69.9% to 89.7% for cervical cancer screening, and from 39.8% to 74.4% for colorectal cancer screening. The multivariable regression model showed that a higher SVI was significantly associated with lower odds of cancer screening, with the lowest odds in the highest SVI quintile. When comparing the highest quintile of SVI (SVI-Q5) with the lowest quintile of SVI (SVI-Q1), the unadjusted odds ratio was 0.86 (95% posterior credible interval [CrI], 0.84-0.87) for breast cancer screening, 0.80 (95% CrI, 0.79-0.81) for cervical cancer screening, and 0.72 (95% CrI, 0.71-0.73) for colorectal cancer screening. When fully adjusted, the odds ratio was 0.92 (95% CrI, 0.90-0.93) for breast cancer screening, 0.87 (95% CrI, 0.86-0.88) for cervical cancer screening, and 0.86 (95% CrI, 0.85-0.88) for colorectal cancer screening, showing slightly attenuated associations. CONCLUSIONS AND RELEVANCE In this cross-sectional study, regional disparities were found in cancer screening rates at a county level. Quantifying how SVI associates with each cancer screening rate could provide insight into the design and focus of future interventions targeting cancer prevention disparities.
Collapse
Affiliation(s)
- Cici Bauer
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Kehe Zhang
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Jiachen Lu
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- UFHealth Cancer Center, Gainesville, Florida
| | - Ryan Suk
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston
| |
Collapse
|
7
|
Mendoza JA, Miller CA, Martin KJ, Resnicow K, Iachan R, Faseru B, McDaniels-Davidson C, Deng Y, Martinez ME, Demark-Wahnefried W, Leader AE, Lazovich D, Jensen JD, Briant KJ, Fuemmeler BF. Examining the Association of Food Insecurity and Being Up-to-Date for Breast and Colorectal Cancer Screenings. Cancer Epidemiol Biomarkers Prev 2022; 31:1017-1025. [PMID: 35247884 PMCID: PMC9135358 DOI: 10.1158/1055-9965.epi-21-1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/05/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Food insecurity (FI) has been associated with poor access to health care. It is unclear whether this association is beyond that predicted by income, education, and health insurance. FI may serve as a target for intervention given the many programs designed to ameliorate FI. We examined the association of FI with being up-to-date to colorectal cancer and breast cancer screening guidelines. METHODS Nine NCI-designated cancer centers surveyed adults in their catchment areas using demographic items and a two-item FI questionnaire. For the colorectal cancer screening sample (n = 4,816), adults ages 50-75 years who reported having a stool test in the past year or a colonoscopy in the past 10 years were considered up-to-date. For the breast cancer screening sample (n = 2,449), female participants ages 50-74 years who reported having a mammogram in the past 2 years were up-to-date. We used logistic regression to examine the association between colorectal cancer or breast cancer screening status and FI, adjusting for race/ethnicity, income, education, health insurance, and other sociodemographic covariates. RESULTS The prevalence of FI was 18.2% and 21.6% among colorectal cancer and breast cancer screening participants, respectively. For screenings, 25.6% of colorectal cancer and 34.1% of breast cancer participants were not up-to-date. In two separate adjusted models, FI was significantly associated with lower odds of being up-to-date with colorectal cancer screening [OR, 0.7; 95% confidence interval (CI), 0.5-0.99)] and breast cancer screening (OR, 0.6; 95% CI, 0.4-0.96). CONCLUSIONS FI was inversely associated with being up-to-date for colorectal cancer and breast cancer screening. IMPACT Future studies should combine FI and cancer screening interventions to improve screening rates.
Collapse
Affiliation(s)
- Jason A. Mendoza
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Carrie A. Miller
- Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | | | - Ken Resnicow
- University of Michigan Rogel Cancer Center and School of Public Health, Ann Arbor, MI
| | | | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
| | | | | | - Maria Elena Martinez
- Moores Cancer Center and Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | | | - Amy E. Leader
- Sidney Kimmel Cancer Center – Jefferson Health and Thomas Jefferson University
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Jakob D. Jensen
- Department of Communication and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Bernard F Fuemmeler
- Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
8
|
Kelly-Brown J, Palmer Kelly E, Obeng-Gyasi S, Chen JC, Pawlik TM. Intersectionality in cancer care: A systematic review of current research and future directions. Psychooncology 2022; 31:705-716. [PMID: 35199401 DOI: 10.1002/pon.5890] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The objective of the current review was to synthesize the literature on intersectionality relative to disparities across the cancer care continuum. A model to support future intersectional cancer research was proposed. METHODS Web-based discovery services and discipline-specific databases were queried for both peer-reviewed and gray literature. Study screening and data extraction were facilitated through the Covidence software platform. RESULTS Among 497 screened studies, 28 met study inclusion criteria. Most articles were peer-reviewed empirical studies (n = 22) that focused on pre-diagnosis/screening (n = 19) and included marginalized racial/ethnic (n = 22) identities. Pre-cancer diagnosis, sexual orientation and race influenced women's screening and vaccine behaviors. Sexual minority women, particularly individuals of color, were less likely to engage in cancer prevention behaviors prior to diagnosis. Race and socioeconomic status (SES) were important factors in patient care/survivorship with worse outcomes among non-white women of low SES. Emergent themes in qualitative results emphasized the importance of patient intersectional identities, as well as feelings of marginalization, fears of discrimination, and general discomfort with providers as barriers to seeking cancer care. CONCLUSIONS Patients with intersectional identities often experience barriers to cancer care that adversely impact screening, diagnosis, treatment, as well as survivorship. The use of an "intersectional lens" as a future clinical and research framework will facilitate a more multidimensional and holistic approach to the care of cancer patients.
Collapse
Affiliation(s)
- Joseph Kelly-Brown
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Elizabeth Palmer Kelly
- Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - J C Chen
- Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| |
Collapse
|
9
|
Lu SSM, Mohammed Z, Häggström C, Myte R, Lindquist E, Gylfe Å, Van Guelpen B, Harlid S. Antibiotics Use and Subsequent Risk of Colorectal Cancer: A Swedish Nationwide Population-Based Study. J Natl Cancer Inst 2021; 114:38-46. [PMID: 34467395 PMCID: PMC8755503 DOI: 10.1093/jnci/djab125] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/12/2021] [Accepted: 06/21/2021] [Indexed: 01/12/2023] Open
Abstract
Background Antibiotics use may increase colorectal cancer (CRC) risk by altering the gut microbiota, with suggestive evidence reported. Our study aims to investigate antibiotics use in relation to subsequent CRC risk. Methods This is a nationwide, population-based study with a matched case-control design (first primary CRC cases and 5 matched, cancer-free controls). Complete-population data, extracted from Swedish national registers for the period 2005-2016, were used to calculate odds ratios and 95% confidence intervals. Results We included 40 545 CRC cases and 202 720 controls. Using the full dataset, we found a positive association between more frequent antibiotics use and CRC, excluding antibiotics prescribed within 2 years of diagnosis attenuated results toward the null. In site-specific analyses, excluding the 2-year washout, the positive association was confined to the proximal colon (adjusted odds ratio for very high use vs no use = 1.17, 95% confidence interval = 1.05 to 1.31). For rectal cancer, an inverse association, which appears to be driven by women, was observed. Quinolones and sulfonamides and/or trimethoprims were positively associated with proximal colon cancer, whereas a more general inverse association, across antibiotics classes, was observed for rectal cancer. We found no association between methenamine hippurate, a urinary tract antiseptic not affecting the gut microbiota, and CRC risk. Conclusions This register-based study covering the entire population of Sweden found a robust association between antibiotics use and higher risk of proximal colon cancer and an inverse association with rectal cancer in women. This study strengthens the evidence from previous investigations and adds important insight into site-specific colorectal carcinogenesis.
Collapse
Affiliation(s)
- Sai San Moon Lu
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Zahraa Mohammed
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Christel Häggström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robin Myte
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Åsa Gylfe
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden.,Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.,Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| |
Collapse
|
10
|
Chen M, Tan X, Padman R. Social determinants of health in electronic health records and their impact on analysis and risk prediction: A systematic review. J Am Med Inform Assoc 2021; 27:1764-1773. [PMID: 33202021 DOI: 10.1093/jamia/ocaa143] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/10/2020] [Accepted: 06/20/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This integrative review identifies and analyzes the extant literature to examine the integration of social determinants of health (SDoH) domains into electronic health records (EHRs), their impact on risk prediction, and the specific outcomes and SDoH domains that have been tracked. MATERIALS AND METHODS In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a literature search in the PubMed, CINAHL, Cochrane, EMBASE, and PsycINFO databases for English language studies published until March 2020 that examined SDoH domains in the context of EHRs. RESULTS Our search strategy identified 71 unique studies that are directly related to the research questions. 75% of the included studies were published since 2017, and 68% were U.S.-based. 79% of the reviewed articles integrated SDoH information from external data sources into EHRs, and the rest of them extracted SDoH information from unstructured clinical notes in the EHRs. We found that all but 1 study using external area-level SDoH data reported minimum contribution to performance improvement in the predictive models. In contrast, studies that incorporated individual-level SDoH data reported improved predictive performance of various outcomes such as service referrals, medication adherence, and risk of 30-day readmission. We also found little consensus on the SDoH measures used in the literature and current screening tools. CONCLUSIONS The literature provides early and rapidly growing evidence that integrating individual-level SDoH into EHRs can assist in risk assessment and predicting healthcare utilization and health outcomes, which further motivates efforts to collect and standardize patient-level SDoH information.
Collapse
Affiliation(s)
- Min Chen
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, USA
| | - Xuan Tan
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, USA
| | - Rema Padman
- The H. John Heinz III College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
11
|
Zhan FB, Morshed N, Kluz N, Candelaria B, Baykal-Caglar E, Khurshid A, Pignone MP. Spatial Insights for Understanding Colorectal Cancer Screening in Disproportionately Affected Populations, Central Texas, 2019. Prev Chronic Dis 2021; 18:E20. [PMID: 33661726 PMCID: PMC7938962 DOI: 10.5888/pcd18.200362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) screening can reduce morbidity and mortality; however, important disparities exist in CRC uptake. Our study examines the associations of distance to care and frequency of using primary care and screening. METHODS To examine the distribution of screening geographically and according to several demographic features, we used individual patient-level data, dated September 30, 2018, from a large urban safety-net health system in Central Texas. We used spatial cluster analysis and logistic regression adjusted for age, race, sex, socioeconomic status, and health insurance status. RESULTS We obtained screening status data for 13,079 age-eligible patients from the health system's electronic medical records. Of those eligible, 55.1% were female, and 55.9% identified as Hispanic. Mean age was 58.1 years. Patients residing more than 20 miles from one of the system's primary care clinics was associated with lower screening rates (odds ratio [OR], 0.63; 95% CI, 0.43-0.93). Patients with higher screening rates included those who had a greater number of primary care-related (nonspecialty) visits within 1 year (OR, 6.90; 95% CI, 6.04-7.88) and those who were part of the county-level medical assistance program (OR, 1.61; 95% CI, 1.40-1.84). Spatial analysis identified an area where the level of CRC screening was particularly low. CONCLUSION Distance to primary care and use of primary care were associated with screening. Priorities in targeted interventions should include identifying and inviting patients with limited care engagements.
Collapse
Affiliation(s)
- F Benjamin Zhan
- LiveStrong Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
- Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos, TX 78666.
| | - Niaz Morshed
- Texas Center for Geographic Information Science, Department of Geography, Texas State University, San Marcos, Texas
| | - Nicole Kluz
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | - Bretta Candelaria
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | | | - Anjum Khurshid
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| | - Michael P Pignone
- LiveStrong Cancer Institutes, Dell Medical School, University of Texas, Austin, Texas
- Departments of Internal Medicine and Population Health, University of Texas Dell Medical School, Austin, Texas
| |
Collapse
|
12
|
Namin S, Zhou Y, Neuner J, Beyer K. The role of residential history in cancer research: A scoping review. Soc Sci Med 2021; 270:113657. [PMID: 33388619 DOI: 10.1016/j.socscimed.2020.113657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/18/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
The role of residential history in cancer prevention, diagnosis, treatment, and survivorship is garnering increasing attention in cancer research. To our knowledge, there is no comprehensive synthesis of the current state of knowledge in the field. We reviewed the extant literature on this topic and conducted a scoping analysis to examine two main research questions: (a) To what degree, and how, have researchers accounted for residential history/mobility in cancer research? and (b) What are the gaps in the literature based on a knowledge synthesis using scoping review and concept mapping? To answer these questions, this scoping analysis focuses on how researchers compile, analyze and discuss residential history/mobility in studies on cancer. The study is focused on peer-reviewed articles from 6 different datasets (PubMed, Cinahl, Scopus, Web of Science and JSTOR, ERIC) from 1990 to August 2020. The review captured 1951 results in total, which was scoped to 281 relevant peer-reviewed journal articles. First, we examined these articles based on cancer continuum, cancer type and the main theme. Second, we identified 21 main themes and an additional 16 sub-themes in the pool of the selected articles. We utilized concept mapping to provide a conceptual framework and to highlight the underlying socioecological assumptions and paradigms. Results show that cancer research incorporating residential histories is primarily focused on incidence and estimating cumulative exposure, with little consideration across the cancer continuum. Additionally, our review suggests that although the social environment plays an important role across the cancer continuum, a small number of articles were focused on such factors and this area remains relatively unexplored. Additionally, the expansion of interdisciplinary research on residential mobility before and after cancer diagnosis will enhance understanding of the role of environmental and socioeconomic characteristics and exposures on cancer continuum.
Collapse
Affiliation(s)
- S Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Y Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Neuner
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - K Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
13
|
Jain NM, Culley A, Knoop T, Micheel C, Osterman T, Levy M. Conceptual Framework to Support Clinical Trial Optimization and End-to-End Enrollment Workflow. JCO Clin Cancer Inform 2020; 3:1-10. [PMID: 31225983 PMCID: PMC6873934 DOI: 10.1200/cci.19.00033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In this work, we present a conceptual framework to support clinical trial optimization and enrollment workflows and review the current state, limitations, and future trends in this space. This framework includes knowledge representation of clinical trials, clinical trial optimization, clinical trial design, enrollment workflows for prospective clinical trial matching, waitlist management, and, finally, evaluation strategies for assessing improvement.
Collapse
Affiliation(s)
- Neha M Jain
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Teresa Knoop
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Mia Levy
- Vanderbilt University Medical Center, Nashville, TN.,Rush University Medical Center, Chicago, IL
| |
Collapse
|
14
|
Thompson CA, Jin A, Luft HS, Lichtensztajn DY, Allen L, Liang SY, Schumacher BT, Gomez SL. Population-Based Registry Linkages to Improve Validity of Electronic Health Record-Based Cancer Research. Cancer Epidemiol Biomarkers Prev 2020; 29:796-806. [PMID: 32066621 DOI: 10.1158/1055-9965.epi-19-0882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/01/2019] [Accepted: 02/12/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There is tremendous potential to leverage the value gained from integrating electronic health records (EHR) and population-based cancer registry data for research. Registries provide diagnosis details, tumor characteristics, and treatment summaries, while EHRs contain rich clinical detail. A carefully conducted cancer registry linkage may also be used to improve the internal and external validity of inferences made from EHR-based studies. METHODS We linked the EHRs of a large, multispecialty, mixed-payer health care system with the statewide cancer registry and assessed the validity of our linked population. For internal validity, we identify patients that might be "missed" in a linkage, threatening the internal validity of an EHR study population. For generalizability, we compared linked cases with all other cancer patients in the 22-county EHR catchment region. RESULTS From an EHR population of 4.5 million, we identified 306,554 patients with cancer, 26% of the catchment region patients with cancer; 22.7% of linked patients were diagnosed with cancer after they migrated away from our health care system highlighting an advantage of system-wide linkage. We observed demographic differences between EHR patients and non-EHR patients in the surrounding region and demonstrated use of selection probabilities with model-based standardization to improve generalizability. CONCLUSIONS Our experiences set the foundation to encourage and inform researchers interested in working with EHRs for cancer research as well as provide context for leveraging linkages to assess and improve validity and generalizability. IMPACT Researchers conducting linkages may benefit from considering one or more of these approaches to establish and evaluate the validity of their EHR-based populations.See all articles in this CEBP Focus section, "Modernizing Population Science."
Collapse
Affiliation(s)
- Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California.
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
- University of California San Diego School of Medicine, San Diego, California
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Daphne Y Lichtensztajn
- Greater Bay Area Cancer Registry, Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
| | - Laura Allen
- Greater Bay Area Cancer Registry, Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Benjamin T Schumacher
- School of Public Health, San Diego State University, San Diego, California
- University of California San Diego School of Medicine, San Diego, California
| | - Scarlett Lin Gomez
- Greater Bay Area Cancer Registry, Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| |
Collapse
|
15
|
Ni K, O'Connell K, Anand S, Yakoubovitch SC, Kwon SC, de Latour RA, Wallach AB, Sherman SE, Du M, Liang PS. Low Colorectal Cancer Screening Uptake and Persistent Disparities in an Underserved Urban Population. Cancer Prev Res (Phila) 2020; 13:395-402. [PMID: 32015094 DOI: 10.1158/1940-6207.capr-19-0440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/01/2020] [Accepted: 01/28/2020] [Indexed: 01/20/2023]
Abstract
Colorectal cancer screening has increased substantially in New York City in recent years. However, screening uptake measured by telephone surveys may not fully capture rates among underserved populations. We measured screening completion within 1 year of a primary care visit among previously unscreened patients in a large urban safety-net hospital and identified sociodemographic and health-related predictors of screening.We identified 21,256 patients ages 50 to 75 who were seen by primary care providers (PCP) in 2014, of whom 14,425 (67.9%) were not up-to-date with screening. Because PCPs facilitate the majority of screening, we compared patients who received screening within 1 year of an initial PCP visit to those who remained unscreened using multivariable logistic regression.Among patients not up-to-date with screening at study outset, 11.5% (1,658 patients) completed screening within 1 year of a PCP visit. Asian race, more PCP visits, and higher area-level income were associated with higher screening completion. Factors associated with remaining unscreened included morbid obesity, ever smoking, Elixhauser comorbidity index of 0, and having Medicaid/Medicare insurance. Age, sex, language, and travel time to the hospital were not associated with screening status. Overall, 39.9% of patients were up-to-date with screening by 2015.In an underserved urban population, colorectal cancer screening disparities remain, and overall screening uptake was low. Because more PCP visits were associated with modestly higher screening completion at 1 year, additional community-level education and outreach may be crucial to increase colorectal cancer screening in underserved populations.
Collapse
Affiliation(s)
- Katherine Ni
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kelli O'Connell
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sanya Anand
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York
| | | | - Simona C Kwon
- Department of Population Health, NYU Langone Health, New York, New York
| | - Rabia Ali de Latour
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York
| | | | - Scott E Sherman
- Department of Population Health, NYU Langone Health, New York, New York
| | - Mengmeng Du
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter S Liang
- Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York. .,Veterans Affairs New York Harbor Health Care System, New York, New York
| |
Collapse
|