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An J, McDougall J, Lin Y, Lu SE, Walters ST, Heidt E, Stroup A, Paddock L, Grumet S, Toppmeyer D, Kinney AY. Randomized trial promoting cancer genetic risk assessment when genetic counseling cost removed: 1-year follow-up. JNCI Cancer Spectr 2024; 8:pkae018. [PMID: 38490263 PMCID: PMC11006111 DOI: 10.1093/jncics/pkae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/07/2023] [Revised: 01/29/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE Cancer genetic risk assessment (CGRA) is recommended for women with ovarian and high-risk breast cancer. However, the underutilization of CGRA has long been documented, and cost has been a major barrier. In this randomized controlled trial, a tailored counseling and navigation (TCN) intervention significantly improved CGRA uptake at 6-month follow-up, compared with targeted print (TP) and usual care (UC). We aimed to examine the effect of removing genetic counseling costs on CGRA uptake by 12 months. METHODS We recruited racially and geographically diverse women with breast and ovarian cancer from cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TCN received telephone-based psychoeducation and navigation. After 6 months, the trial provided free genetic counseling to participants in all arms. RESULTS At 12 months, more women in TCN obtained CGRA (26.6%) than those in TP (11.0%; odds ratio [OR] = 2.77, 95% confidence interval [CI] = 1.56 to 4.89) and UC (12.2%; OR = 2.46, 95% CI = 1.41 to 4.29). There were no significant differences in CGRA uptake between TP and UC. The Kaplan-Meier curve shows that the divergence of cumulative incidence slopes (TCN vs UC, TCN vs TP) appears primarily within the initial 6 months. CONCLUSION TCN significantly increased CGRA uptake at the 12-month follow-up. Directly removing the costs of genetic counseling attenuated the effects of TCN, highlighting the critical enabling role played by cost coverage. Future policies and interventions should address multilevel cost-related barriers to expand patients' access to CGRA. TRIAL REGISTRATION This trial was registered with the NIH clinical trial registry, clinicaltrials.gov, NCT03326713. https://clinicaltrials.gov/ct2/show/NCT03326713.
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Affiliation(s)
- Jinghua An
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Yong Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Shou-En Lu
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Scott T Walters
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Emily Heidt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Lisa Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Sherry Grumet
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Anita Y Kinney
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Rutgers University School of Public Health, Piscataway, NJ, USA
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Smith KS, Hoogland AI, Welniak T, Nguyen OL, Rodriguez Y, Li X, Crowder SL, Oswald LB, Carpenter KM, Fischer SM, Li D, Kinney AY, Berry DL, Gonzalez BD, Jim HSL. Acute cancer-related symptoms and concerns among patients receiving chemotherapy: current state of the science. Support Care Cancer 2024; 32:184. [PMID: 38393418 DOI: 10.1007/s00520-024-08385-7] [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: 09/13/2023] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE This study provides an updated evaluation of the prevalence and severity of acute cancer-related symptoms and quality of life (QOL) concerns among patients treated with emetogenic chemotherapy. METHODS Patients were recruited to a larger, multi-site observational study prior to starting chemotherapy. Participants completed sociodemographic questionnaires and clinical data were abstracted via medical record review. Symptoms and QOL were assessed 5 days after starting moderately or highly emetogenic chemotherapy. Functional Assessment of Cancer Therapy - General assessed QOL concerns. Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events evaluated symptoms. Symptoms were considered severe when participants responded "severe" or "very severe." RESULTS Participants (N = 1174) were on average 58 ± 13 years, mostly female (73%), non-Hispanic (89%), and White (87%). Most participants were diagnosed with breast (38.1%), gynecological (20%), and gastrointestinal (17.1%) cancer. The most common QOL concerns of any severity were fatigue (94%), anhedonia (89%), dissatisfaction with QOL (86%), and sleep disturbance (86%). The most common severe QOL concerns were anhedonia (44%), fatigue (40%), and inability to work (38%). Decreased appetite (74%), pain (71%), and constipation (70%) were the most common symptoms of any severity, as well as most common severe symptoms (13%, 18%, and 18%, respectively). CONCLUSION Herein, updates are provided in regard to QOL concerns and symptoms reported by patients in the days after chemotherapy and demonstrates that concerns and symptoms have shifted in the last decade.
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Affiliation(s)
- Kristen S Smith
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Taylor Welniak
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Oanh L Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Yvelise Rodriguez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Sylvia L Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Kristen M Carpenter
- Department of Psychiatry and Behavioral Health, The Ohio State University Medical Center, Columbus, OH, USA
| | - Stacy M Fischer
- Department of General Internal Medicine, University of Colorado Denver, Denver, CO, USA
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Donna L Berry
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA
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Satagopan JM, Dharamdasani T, Mathur S, Kohler RE, Bandera EV, Kinney AY. Experiences and lessons learned from community-engaged recruitment for the South Asian breast cancer study in New Jersey during the COVID-19 pandemic. PLoS One 2023; 18:e0294170. [PMID: 37956167 PMCID: PMC10642833 DOI: 10.1371/journal.pone.0294170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND South Asians are a rapidly growing population in the United States. Breast cancer is a major concern among South Asian American women, who are an understudied population. We established the South Asian Breast Cancer (SABCa) study in New Jersey during early 2020 to gain insights into their breast cancer-related health attitudes. Shortly after we started planning for the study, the COVID-19 disease spread throughout the world. In this paper, we describe our experiences and lessons learned from recruiting study participants by partnering with New Jersey's community organizations during the COVID-19 pandemic. METHODS We used a cross-sectional design. We contacted 12 community organizations and 7 (58%) disseminated our study information. However, these organizations became considerably busy with pandemic-related needs. Therefore, we had to pivot to alternative recruitment strategies through community radio, Rutgers Cancer Institute of New Jersey's Community Outreach and Engagement Program, and Rutgers Cooperative Extension's community health programs. We recruited participants through these alternative strategies, obtained written informed consent, and collected demographic information using a structured survey. RESULTS Twenty five women expressed interest in the study, of which 22 (88%) participated. Nine (41%) participants learned about the study through the radio, 5 (23%) through these participants, 1 (4.5%) through a non-radio community organization, and 7 (32%) through community health programs. Two (9%) participants heard about the study from their spouse. All participants were born outside the US, their average age was 52.4 years (range: 39-72 years), and they have lived in the US for an average of 26 years (range: 5-51 years). CONCLUSION Pivoting to alternative strategies were crucial for successful recruitment. Findings suggest the significant potential of broadcast media for community-based recruitment. Family dynamics and the community's trust in our partners also encouraged participation. Such strategies must be considered when working with understudied populations.
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Affiliation(s)
- Jaya M. Satagopan
- Department of Biostatistics and Epidemiology, School of Public Health, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Tina Dharamdasani
- Department of Biostatistics and Epidemiology, School of Public Health, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Shailja Mathur
- Department of Family and Community Health Sciences, Cooperative Extension, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Racquel E. Kohler
- Department of Health Behavior, Society & Policy, School of Public Health, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Anita Y. Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
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Kinney AY, Stroup AM, Scharf S, Libutti SK. Rutgers Cancer Institute of New Jersey's Community Outreach and Engagement Approach to Cancer Prevention. Cancer Prev Res (Phila) 2023; 16:595-600. [PMID: 37908146 PMCID: PMC10618643 DOI: 10.1158/1940-6207.capr-23-0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/18/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/02/2023]
Abstract
Rutgers Cancer Institute of New Jersey (New Brunswick, NJ) is committed to providing cancer prevention education, outreach, and clinical services in our catchment area (CA). Our approach to cancer prevention includes ongoing surveillance to better understand the CA cancer burden and opportunities for intervention, leveraging community partnerships, and vigorously engaging diverse communities to understand and address their needs. This approach considers individual, sociocultural, environmental, biologic, system, and policy-level factors with an equity lens. Rutgers Cancer Institute has had substantial impact on cancer prevention (risk reduction, screening, and early detection) over the past five years, including the development of a CA data dashboard advancing implementation of evidence-based cancer control actions by leveraging 357 healthcare and community partners (with 522 partner sites). Furthermore, we provided professional education (attendance 19,397), technical assistance to community organizations (1,875 support sessions), educational outreach for community members (87,000+ through direct education), facilitated access to preventive services (e.g., 60,000+ screenings resulting in the detection of >2,000 malignant and premalignant lesions), contributed to advances in health policy and population-level improvements in risk reduction behaviors, screening, and incidence. With longer-term data, we will assess the impact of our cancer prevention efforts on cancer incidence, downward shifts in stage at diagnosis, mortality, and disparities.
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Affiliation(s)
- Anita Y. Kinney
- Rutgers University School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Antoinette M. Stroup
- Rutgers University School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sarah Scharf
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Steven K. Libutti
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
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An J, Lu SE, McDougall J, Walters ST, Lin Y, Heidt E, Stroup A, Paddock L, Grumet S, Toppmeyer D, Kinney AY. Identifying Mediators of Intervention Effects Within a Randomized Controlled Trial to Motivate Cancer Genetic Risk Assessment Among Breast and Ovarian Cancer Survivors. Ann Behav Med 2023; 57:965-977. [PMID: 37658805 PMCID: PMC10578392 DOI: 10.1093/abm/kaad048] [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] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND A theory-guided Tailored Counseling and Navigation (TCN) intervention successfully increased cancer genetic risk assessment (CGRA) uptake among cancer survivors at increased risk of hereditary breast and ovarian cancer (HBOC). Understanding the pathways by which interventions motivate behavior change is important for identifying the intervention's active components. PURPOSE We examined whether the TCN intervention exerted effects on CGRA uptake through hypothesized theoretical mediators. METHODS Cancer survivors at elevated risk for HBOC were recruited from three statewide cancer registries and were randomly assigned to three arms: TCN (n = 212), Targeted Print (TP, n = 216), and Usual Care (UC, n = 213). Theoretical mediators from the Extended Parallel Process Model, Health Action Planning Approach, and Ottawa Decision Support Framework were assessed at baseline and 1-month follow-up; CGRA uptake was assessed at 6 months. Generalized structural equation modeling was used for mediation analysis. RESULTS The TCN effects were most strongly mediated by behavioral intention alone (β = 0.49 and 0.31) and by serial mediation through self-efficacy and intention (β = 0.041 and 0.10) when compared with UC and TP, respectively. In addition, compared with UC, the TCN also increased CGRA through increased perceived susceptibility, knowledge of HBOC, and response efficacy. CONCLUSIONS Risk communication and behavioral change interventions for hereditary cancer should stress a person's increased genetic risk and the potential benefits of genetic counseling and testing, as well as bolster efficacy beliefs by helping remove barriers to CGRA. System-level and policy interventions are needed to further expand access.
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Affiliation(s)
- Jinghua An
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Shou-En Lu
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
| | | | - Scott T Walters
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
| | - Emily Heidt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
| | - Lisa Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
| | - Sherry Grumet
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Anita Y Kinney
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
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An J, Ferrante JM, Macenat M, Ganesan S, Hudson SV, Omene C, Garcia H, Kinney AY. Promoting informed approaches in precision oncology and clinical trial participation for Black patients with cancer: Community-engaged development and pilot testing of a digital intervention. Cancer 2023. [PMID: 37837177 DOI: 10.1002/cncr.35049] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Black patients with cancer are less likely to receive precision cancer treatments than White patients and are underrepresented in clinical trials. To address these disparities, the study aimed to develop and pilot-test a digital intervention to improve Black patients' knowledge about precision oncology and clinical trials, empower patients to increase relevant discussion, and promote informed decision-making. METHODS A community-engaged approach, including a Community Advisory Board and two rounds of key informant interviews with Black patients with cancer, their relatives, and providers (n = 48) was used to develop and refine the multimedia digital intervention. Thematic analysis was conducted for qualitative data. The intervention was then pilot-tested with 30 Black patients with cancer to assess feasibility, acceptability, appropriateness, knowledge, decision self-efficacy, and patient empowerment; Wilcoxon matched pairs signed-rank test was used to analyze quantitative data. RESULTS The digital tool was found to be feasible, acceptable, and culturally appropriate. Key informants shared their preferences and recommendations for the digital intervention and helped improve cultural appropriateness through user and usability testing. In the pilot test, appreciable improvement was found in participants' knowledge about precision oncology (z = -2.04, p = .052), knowledge about clinical trials (z = -3.14, p = .001), and decisional self-efficacy for targeted/immune therapy (z = -1.96, p = .0495). CONCLUSIONS The digital intervention could be a promising interactive decision-support tool for increasing Black patients' participation in clinical trials and receipt of precision treatments, including immunotherapy. Its use in clinical practice may reduce disparities in oncology care and research. PLAIN LANGUAGE SUMMARY We developed a digital interactive decision support tool for Black patients with cancer by convening a Community Advisory Board and conducting interviews with Black patients with cancer, their relatives, and providers. We then pilot-tested the intervention with newly diagnosed Black patients with cancer and found appreciable improvement in participants' knowledge about precision oncology, knowledge about clinical trials, and confidence in making decisions for targeted/immune therapy. Our digital tool has great potential to be an affordable and scalable solution for empowering and educating Black patients with cancer to help them make informed decisions about precision oncology and clinical trials and ultimately reducing racial disparities.
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Affiliation(s)
- Jinghua An
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Jeanne M Ferrante
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Myneka Macenat
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Shawna V Hudson
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Coral Omene
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Harold Garcia
- Lawrence Herbert School of Communication, Hofstra University, Hempstead, New York, USA
| | - Anita Y Kinney
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- School of Public Health, The State University of New Jersey, New Brunswick, New Jersey, USA
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Metcalfe KA, Pal T, Narod SA, Armel S, Shickh S, Buckley K, Walters ST, Brennenstuhl S, Kinney AY. Theory-based behavior change intervention to increase uptake of risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 pathogenic variant: The PREVENT randomized controlled trial. Cancer Med 2023; 12:18246-18257. [PMID: 37602539 PMCID: PMC10524042 DOI: 10.1002/cam4.6417] [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: 10/14/2022] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE To evaluate the effect of a theory-based behavioral intervention delivered by genetic counselors on the uptake of risk-reducing salpingo-oophorectomy (RRSO) at 12 and 24 months by women with a BRCA1 or BRCA2 pathogenic variant (PV) compared to women who received usual care. METHODS In this two-arm, multi-site randomized controlled trial participants were randomized to receive a theoretically-guided behavioral telephone intervention or usual care. Outcome data were collected at 12 and 24 months. Participants in the usual care arm were offered the intervention after 12 months. RESULTS Data on 107 participants were included in the analysis. There was no significant difference in the proportion of women who had a RRSO by 1 year (28.6%- intervention; 22.9%- usual care (p = 0.54)). At 1 year, women who received the intervention had significantly lower mean decisional conflict (pinteraction <0.001) and a higher mean knowledge score at one-year compared to usual care (pinteraction <0.001). At 2 years, 53.9% of participants in the intervention arm had RRSO compared to 32.6% in usual care (p = 0.05). CONCLUSIONS A theory-based behavioral intervention delivered by genetic counselors to women with a BRCA PV who chose not to have the recommended RRSO was effective at reducing decisional conflict and increasing knowledge in women with a BRCA1 or BRCA2 PV.
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Affiliation(s)
- Kelly A. Metcalfe
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
- Women's College Research InstituteTorontoOntarioCanada
| | - Tuya Pal
- Vanderbilt‐Ingram Cancer Center at the Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Susan Armel
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Salma Shickh
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | | | - Scott T. Walters
- University of North Texas Health Science CenterFort WorthTexasUSA
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoOntarioCanada
| | - Anita Y. Kinney
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
- Department of Biostatistics and Epidemiology, School of Public HealthRutgers UniversityPiscatawayNew JerseyUSA
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Ellis SD, Brooks JV, Birken SA, Morrow E, Hilbig ZS, Wulff-Burchfield E, Kinney AY, Ellerbeck EF. Determinants of targeted cancer therapy use in community oncology practice: a qualitative study using the Theoretical Domains Framework and Rummler-Brache process mapping. Implement Sci Commun 2023; 4:66. [PMID: 37308981 PMCID: PMC10259814 DOI: 10.1186/s43058-023-00441-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Precision medicine holds enormous potential to improve outcomes for cancer patients, offering improved rates of cancer control and quality of life. Not all patients who could benefit from targeted cancer therapy receive it, and some who may not benefit do receive targeted therapy. We sought to comprehensively identify determinants of targeted therapy use among community oncology programs, where most cancer patients receive their care. METHODS Guided by the Theoretical Domains Framework, we conducted semi-structured interviews with 24 community cancer care providers and mapped targeted therapy delivery across 11 cancer care delivery teams using a Rummler-Brache diagram. Transcripts were coded to the framework using template analysis, and inductive coding was used to identify key behaviors. Coding was revised until a consensus was reached. RESULTS Intention to deliver precision medicine was high across all participants interviewed, who also reported untenable knowledge demands. We identified distinctly different teams, processes, and determinants for (1) genomic test ordering and (2) delivery of targeted therapies. A key determinant of molecular testing was role alignment. The dominant expectation for oncologists to order and interpret genomic tests is at odds with their role as treatment decision-makers' and pathologists' typical role to stage tumors. Programs in which pathologists considered genomic test ordering as part of their staging responsibilities reported high and timely testing rates. Determinants of treatment delivery were contingent on resources and ability to offset delivery costs, which low- volume programs could not do. Rural programs faced additional treatment delivery challenges. CONCLUSIONS We identified novel determinants of targeted therapy delivery that potentially could be addressed through role re-alignment. Standardized, pathology-initiated genomic testing may prove fruitful in ensuring patients eligible for targeted therapy are identified, even if the care they need cannot be delivered at small and rural sites which may have distinct challenges in treatment delivery. Incorporating behavior specification and Rummler-Brache process mapping with determinant analysis may extend its usefulness beyond the identification of the need for contextual adaptation.
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Affiliation(s)
- Shellie D. Ellis
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | - Joanna Veazey Brooks
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | - Sarah A. Birken
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC 27101 USA
| | - Emily Morrow
- Kansas City Kansas Community College, 7250 State Ave., Kansas City, KS 66112 USA
| | - Zachary S. Hilbig
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | | | - Anita Y. Kinney
- Rutgers Cancer Institute of New Jersey, Rutgers University, 195 Little Albany St., New Brunswick, NJ 08901 USA
| | - Edward F. Ellerbeck
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
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Kinney AY, Walters ST, Lin Y, Lu SE, Kim A, Ani J, Heidt E, Le Compte CJ, O'Malley D, Stroup A, Paddock LE, Grumet S, Boyce TW, Toppmeyer DL, McDougall JA. Improving Uptake of Cancer Genetic Risk Assessment in a Remote Tailored Risk Communication and Navigation Intervention: Large Effect Size but Room to Grow. J Clin Oncol 2023; 41:2767-2778. [PMID: 36787512 PMCID: PMC10414736 DOI: 10.1200/jco.22.00751] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/30/2022] [Revised: 11/21/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE Cancer genetic risk assessment (CGRA) is recommended for women with ovarian cancer or high-risk breast cancer, yet fewer than 30% receive recommended genetic services, with the lowest rates among underserved populations. We hypothesized that compared with usual care (UC) and mailed targeted print (TP) education, CGRA uptake would be highest among women receiving a phone-based tailored risk counseling and navigation intervention (TCN). METHODS In this three-arm randomized trial, women with ovarian or high-risk breast cancer were recruited from statewide cancer registries in Colorado, New Jersey, and New Mexico. Participants assigned to TP received a mailed educational brochure. Participants assigned to TCN received the mailed educational brochure, an initial phone-based psychoeducational session with a health coach, a follow-up letter, and a follow-up navigation phone call. RESULTS Participants' average age was 61 years, 25.4% identified as Hispanic, 5.9% identified as non-Hispanic Black, and 17.5% lived in rural areas. At 6 months, more women in TCN received CGRA (18.7%) than those in TP (3%; odds ratio, 7.4; 95% CI, 3.0 to 18.3; P < .0001) or UC (2.5%; odds ratio, 8.9; 95% CI, 3.4 to 23.5; P < .0001). There were no significant differences in CGRA uptake between TP and UC. Commonly cited barriers to genetic counseling were lack of provider referral (33.7%) and cost (26.5%), whereas anticipated difficulty coping with test results (14.0%) and cost (41.2%) were barriers for genetic testing. CONCLUSION TCN increased CGRA uptake in a group of geographically and ethnically diverse high-risk breast and ovarian cancer survivors. Remote personalized interventions that incorporate evidence-based health communication and behavior change strategies may increase CGRA among women recruited from statewide cancer registries.
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Affiliation(s)
- Anita Y. Kinney
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Yong Lin
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Shou-En Lu
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Arreum Kim
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Julianne Ani
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Emily Heidt
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Denalee O'Malley
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- School of Medicine, Rutgers University, The State University of New Jersey, Newark, NJ
| | - Antoinette Stroup
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Lisa E. Paddock
- Rutgers University School of Public Health, Rutgers University, The State University of New Jersey, Newark, NJ
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sherry Grumet
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tawny W. Boyce
- UNM Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM
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Manne SL, Knott CL, Berger A, Champion VL, Chrischilles E, Fitzgibbon ML, Kinney AY, Lengerich EJ, Nash SH, Simon MA, Trentham-Dietz A, Paskett ED. Current Approaches to Serving Catchment Areas in Cancer Centers: Insights from the Big Ten Cancer Research Consortium Population Science Working Group. Cancer Epidemiol Biomarkers Prev 2023; 32:465-472. [PMID: 37009690 DOI: 10.1158/1055-9965.epi-22-0958] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/09/2022] [Revised: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 04/04/2023] Open
Abstract
In 2021, the NCI issued updated guidance clarifying the mission and organizational structure for Community Outreach and Engagement (COE) for Cancer Center Support Grants. These guidelines outlined how cancer centers should address the cancer burden of the catchment area (CA) and define how COE would partner with the community to inform cancer research and implement programs to reduce the cancer burden. In this paper, the Common Elements Committee of the Population Science Working Group in the Big Ten Cancer Research Consortium describes their respective approaches to implementing these guidelines. We discuss our definitions and rationales for each CA, data sources used, and our approach to assessing the impact of COE efforts on the burden of cancer in our respective CA. Importantly, we describe methods of translating unmet CA needs into our cancer-relevant outreach activities, and cancer research addressing the needs of respective CAs. Implementing these new guidelines is a challenge, and we hope that sharing approaches and experiences will foster cross-center collaborations that may more effectively reduce the burden of cancer in the US and meet the mission of the NCI's Cancer Center Program.
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Affiliation(s)
- Sharon L Manne
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Cheryl L Knott
- Department of Behavioral and Community Health, University of Maryland, College Park, Maryland
| | - Ann Berger
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Victoria L Champion
- School of Nursing, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Elizabeth Chrischilles
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Marian L Fitzgibbon
- Department of Pediatrics, University of Illinois Cancer Center, Chicago, Illinois
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Eugene J Lengerich
- Department of Public Health Sciences, Penn State Cancer Institute, The Pennsylvania State University, Hershey, Pennsylvania
| | - Sarah H Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Melissa A Simon
- Preventive Medicine and Medical Social Sciences, Northwestern University, Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Electra D Paskett
- College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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11
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Crowder SL, Welniak TL, Hoogland AI, Small BJ, Rodriguez Y, Carpenter KM, Fischer SM, Li D, Kinney AY, Rotroff D, Mariam A, Brownstein N, Reich RR, Hembree T, Playdon MC, Arthur AE, Vieytes CAM, Li Z, Extermann M, Kim R, Berry DL, Jim HSL. Diet quality indices and changes in cognition during chemotherapy. Support Care Cancer 2022; 31:75. [PMID: 36544032 PMCID: PMC10127432 DOI: 10.1007/s00520-022-07513-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE No evidence-based prevention strategies currently exist for cancer-related cognitive decline (CRCD). Although patients are often advised to engage in healthy lifestyle activities (e.g., nutritious diet), little is known about the impact of diet on preventing CRCD. This secondary analysis evaluated the association of pre-treatment diet quality indices on change in self-reported cognition during chemotherapy. METHODS Study participants (n = 96) completed the Block Brief Food Frequency Questionnaire (FFQ) before receiving their first infusion and the PROMIS cognitive function and cognitive abilities questionnaires before infusion and again 5 days later (i.e., when symptoms were expected to be their worst). Diet quality indices included the Dietary Approaches to Stop Hypertension (DASH), Alternate Mediterranean Diet (aMED), and a low carbohydrate diet index and their components. Descriptive statistics were generated for demographic and clinical variables and diet indices. Residualized change models were computed to examine whether diet was associated with change in cognitive function and cognitive abilities, controlling for age, sex, cancer type, treatment type, depression, and fatigue. RESULTS Study participants had a mean age of 59 ± 10.8 years and 69% were female. Although total diet index scores did not predict change in cognitive function or cognitive abilities, higher pre-treatment ratio of aMED monounsaturated/saturated fat was associated with less decline in cognitive function and cognitive abilities at 5-day post-infusion (P ≤ .001). CONCLUSIONS Higher pre-treatment ratio of monounsaturated/saturated fat intake was associated with less CRCD early in chemotherapy. Results suggest greater monounsaturated fat and less saturated fat intake could be protective against CRCD during chemotherapy.
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Affiliation(s)
- Sylvia L Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Taylor L Welniak
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Yvelise Rodriguez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Stacy M Fischer
- Department of General Internal Medicine, University of Colorado Denver, Denver, CO, USA
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Daniel Rotroff
- Department of Quantitative Health Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Endocrinology and Metabolism Institute, Cleveland, OH, USA
| | - Arshiya Mariam
- Department of Quantitative Health Sciences, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Naomi Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Reich
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Tim Hembree
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, FL, USA
| | - Mary C Playdon
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Anna E Arthur
- Department of Dietetics and Nutrition, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Christian AMaino Vieytes
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Zonggui Li
- Department of Psychology and Neuroscience, Boston College, Newtown, MA, USA
| | - Martine Extermann
- Department of Senior Adult Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard Kim
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Donna L Berry
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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12
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Le Compte CG, Lu SE, Ani J, McDougall J, Walters ST, Toppmeyer D, Boyce TW, Stroup A, Paddock L, Grumet S, Lin Y, Heidt E, Kinney AY. Understanding cancer genetic risk assessment motivations in a remote tailored risk communication and navigation intervention randomized controlled trial. Health Psychol Behav Med 2022; 10:1190-1215. [PMID: 36518606 PMCID: PMC9744218 DOI: 10.1080/21642850.2022.2150623] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022] Open
Abstract
Background National guidelines recommend cancer genetic risk assessment (CGRA) (i.e. genetic counseling prior to genetic testing) for women at increased risk for hereditary breast and ovarian cancer (HBOC). Less than one-half of eligible women obtain CGRA, leaving thousands of women and their family members without access to potentially life-saving cancer prevention interventions. Purpose The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE) addressed this translational gap, testing the efficacy of a tailored counseling and navigation (TCN) intervention vs. a targeted print brochure vs. usual care on CGRA intentions. Selected behavioral variables were theorized to mediate CGRA intentions. Methods Breast and ovarian cancer survivors meeting criteria for guideline-based CGRA were recruited from three state cancer registries (N = 654), completed a baseline survey, and were randomized. TCN and targeted print arms received the brochure; TCN also participated in a tailored, telephone-based decision coaching and navigation session grounded in the Extended Parallel Process Model and Ottawa Decision Support Framework. Participants completed a one-month assessment. Logistic regression was used to compare the rate of CGRA intentions. CGRA intentions and theorized mediator scores (continuous level variables) were calculated using mixed model analysis. Results CGRA intentions increased for TCN (53.2%) vs. targeted print (26.7%) (OR = 3.129; 95% CI: 2.028, 4.827, p < .0001) and TCN vs. usual care (23.1%) (OR = 3.778, CI: 2.422, 5.894, p < .0001). Perceived risk (p = 0.023) and self-efficacy (p = 0.035) mediated CGRA intentions in TCN. Conclusions Improvements in CGRA intentions and theorized mediators support the use of a tailored communication intervention among women at increased HBOC risk. (Clinicaltrials.gov: NCT03326713.)Trial registration: ClinicalTrials.gov identifier: NCT03326713.
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Affiliation(s)
- Circe Gray Le Compte
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Shou-En Lu
- Rutgers Environmental Epidemiology and Statistics, Rutgers University School of Public Health, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
| | - Julianne Ani
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jean McDougall
- Department of Internal Medicine, Division of Epidemiology, Biostatistics, and Preventive Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Scott T. Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Deborah Toppmeyer
- Stacy Goldstein Breast Cancer Center, LIFE Center, Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Tawny W. Boyce
- Biostatistics Shared Resource, UNM Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Antoinette Stroup
- New Jersey State Cancer Registry, Stroup Research Center, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Lisa Paddock
- Cancer Surveillance Research Program, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Sherry Grumet
- LIFE Center, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Yong Lin
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
| | - Emily Heidt
- Biobehavioral Cancer Health Equity Research Lab, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Anita Y. Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey University, New Brunswick, NJ, USA
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Crowder SL, Hoogland AI, Small BJ, Carpenter KM, Fischer SM, Li D, Kinney AY, Welniak TL, Brownstein N, Reich RR, Hembree T, Extermann M, Kim R, Afiat TP, Berry DL, Turner K, Jim HSL. Associations among frailty and quality of life in older patients with cancer treated with chemotherapy. J Geriatr Oncol 2022; 13:1149-1155. [PMID: 36008271 PMCID: PMC9871794 DOI: 10.1016/j.jgo.2022.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/21/2022] [Revised: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Previous studies have suggested that frailty among older adults with cancer is associated with a variety of negative outcomes, including greater chemotherapy toxicity and worse survival. However, results often do not include patient-reported outcomes, such as quality of life (QOL). The objective of this study was to evaluate frailty prior to receipt of moderately- or highly-emetogenic chemotherapy and acute changes in QOL in patients at least 65 years of age. It was hypothesized that frail patients would report greater declines in QOL. MATERIALS AND METHODS Participants completed questionnaires before receiving their first infusion and again five days later. A 59-item deficit accumulation index score was created at baseline using a modified Rockwood frailty index. QOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The relationship between baseline frailty and QOL was evaluated using a dichotomized deficit accumulation index (frail vs. robust) in repeated measures ANOVA. RESULTS Study participants (n = 151) had a mean age of 72 (SD = 4.5) and 62% were female. Nearly half (42%) were frail at baseline. Frail participants reported worse QOL at baseline compared to robust participants. Frail patients reported smaller declines in overall and physical (p < 0.0001) and emotional (p = 0.006) QOL from baseline to five days after receiving chemotherapy. At five days, frail participants reported better emotional and physical QOL compared to robust participants. DISCUSSION Contrary to expectations, frail patients reported smaller declines in QOL compared to robust patients using a deficit accumulation index. These results can be used to help educate frail patients on what to expect during treatment.
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Affiliation(s)
- Sylvia L Crowder
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Aasha I Hoogland
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Brent J Small
- University of South Florida, School of Aging Studies, United States of America
| | - Kristen M Carpenter
- The Ohio State University, Department of Psychiatry, United States of America
| | - Stacy M Fischer
- University of Colorado Denver, Department of General Internal Medicine, United States of America
| | - Daneng Li
- City of Hope Comprehensive Cancer Center, Department of Medical Oncology and Therapeutics Research, United States of America
| | - Anita Y Kinney
- Rutgers University, Department of Biostatistics and Epidemiology, School of Public Health, United States of America
| | - Taylor L Welniak
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Naomi Brownstein
- Moffitt Cancer Center, Biostatistics and Bioinformatics Shared Resource, United States of America
| | - Richard R Reich
- Moffitt Cancer Center, Biostatistics and Bioinformatics Shared Resource, United States of America
| | - Tim Hembree
- Moffitt Cancer Center, Department of Internal and Hospital Medicine, United States of America
| | - Martine Extermann
- Moffitt Cancer Center, Department of Senior Adult Oncology, United States of America
| | - Richard Kim
- Moffitt Cancer Center, Department of Gastrointestinal Oncology, United States of America
| | - Thanh-Phuong Afiat
- Moffitt Cancer Center, Department of Internal and Hospital Medicine, United States of America
| | - Donna L Berry
- University of Washington, Biobehavioral Nursing and Health Informatics, United States of America
| | - Kea Turner
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America
| | - Heather S L Jim
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, United States of America.
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Ellis SD, Thompson JA, Boyd SS, Roberts AW, Charlton M, Brooks JV, Birken SA, Wulff-Burchfield E, Amponsah J, Petersen S, Kinney AY, Ellerbeck E. Geographic differences in community oncology provider and practice location characteristics in the central United States. J Rural Health 2022; 38:865-875. [PMID: 35384064 PMCID: PMC9589478 DOI: 10.1111/jrh.12663] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE How care delivery influences urban-rural disparities in cancer outcomes is unclear. We sought to understand community oncologists' practice settings to inform cancer care delivery interventions. METHODS We conducted secondary analysis of a national dataset of providers billing Medicare from June 1, 2019 to May 31, 2020 in 13 states in the central United States. We used Kruskal-Wallis rank and Fisher's exact tests to compare physician characteristics and practice settings among rural and urban community oncologists. FINDINGS We identified 1,963 oncologists practicing in 1,492 community locations; 67.5% practiced in exclusively urban locations, 11.3% in exclusively rural locations, and 21.1% in both rural and urban locations. Rural-only, urban-only, and urban-rural spanning oncologists practice in an average of 1.6, 2.4, and 5.1 different locations, respectively. A higher proportion of rural community sites were solo practices (11.7% vs 4.0%, P<.001) or single specialty practices (16.4% vs 9.4%, P<.001); and had less diversity in training environments (86.5% vs 67.8% with <2 medical schools represented, P<.001) than urban community sites. Rural multispecialty group sites were less likely to include other cancer specialists. CONCLUSIONS We identified 2 potentially distinct styles of care delivery in rural communities, which may require distinct interventions: (1) innovation-isolated rural oncologists, who are more likely to be solo providers, provide care at few locations, and practice with doctors with similar training experiences; and (2) urban-rural spanning oncologists who provide care at a high number of locations and have potential to spread innovation, but may face high complexity and limited opportunity for care standardization.
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Affiliation(s)
- Shellie D Ellis
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Jeffrey A Thompson
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Samuel S Boyd
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew W Roberts
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mary Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Sarah A Birken
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Elizabeth Wulff-Burchfield
- University of Kansas Cancer Center, Kansas City, Kansas, USA
- Division of Medical Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jonah Amponsah
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shariska Petersen
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Haven, Kansas, USA
| | - Edward Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, Kansas City, Kansas, USA
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LeCompte CG, McDougall J, Walters ST, Toppmeyer D, Boyce TW, Lu S, Stroup A, Paddock L, Grumet S, Lin Y, Ani J, Heidt E, Kinney AY. Understanding Cancer Genetic Risk Assessment Intentions in a Tailored Risk Communication Intervention Randomized Controlled Trial. Cancer Epidemiol Biomarkers Prev 2022. [PMID: 35775212 DOI: 10.1158/1055-9965.epi-22-0482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pathogenic variants in cancer predisposition genes increase second, hereditary cancer risk among women with breast and/or ovarian cancer, and primary cancers in their relatives. National guidelines recommend cancer genetic risk assessment (CGRA) (genetic counseling and/or genetic testing) for women at increased hereditary breast and ovarian cancer (HBOC) risk. Yet, less than half of high risk women, including rural dwellers and racial minorities have accessed CGRA. PURPOSE The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE), a superiority trial, addressed this translational gap, testing the efficacy of a targeted print brochure (TP) vs tailored counseling and navigation (TCN) vs usual care (UC) on CGRA intentions. TCN targeted behavioral variables theorized to mediate CGRA intentions. We believe GRACE is the first study of its kind promoting guideline-based CGRA to women at increased HBOC risk. METHODS CGRA-eligible women were recruited from three state cancer registries (N=641), completed a baseline survey, and randomized to TCN, TP or UC. TP and TCN received the mailed educational brochure. TCN also engaged in a telephone-based decision coaching and navigation session using motivational interviewing and tailored materials based on the Extended Parallel Process Model and Health Action Process Approach. Participants completed a follow-up survey at one month. RESULTS TCN improved CGRA intentions compared to TP (0.64, p<0.001, CI 0.32, 0.97) and UC (0.69, p<0.001, CI 0.37, 1.02). Theoretical targets, perceived risk (0.77, p=0.02, CI 0.11, 1.44) and self-efficacy (0.67, p=0.04, CI 0.05, 1.28) mediated CGRA intentions in TCN. Stratification showed increases in CGRA intentions for TCN vs TP among non-Hispanic Whites, Hispanics, urban dwellers, and women with low health literacy and no family history of breast and/or ovarian cancer (FBOC). In TCN, perceived self-efficacy improved in women with no FBOC. CONCLUSIONS Improvements in CGRA intentions and theorized mediators support use of tailored risk communication interventions in Hispanics and women with low health literacy and no FBOC. Further tailoring may improve CGRA intentions in Blacks, other minorities, rural dwellers, and women with high health literacy and FBOC.
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Witt CM, Balneaves LG, Carlson LE, Cohen M, Deng G, Fouladbakhsh JM, Kinney AY, Mehta A, Mailman J, Pole L, Rogge AA, O'Toole C, Zick SM, Helmer SM. Education Competencies for Integrative Oncology-Results of a Systematic Review and an International and Interprofessional Consensus Procedure. J Cancer Educ 2022; 37:499-507. [PMID: 32783117 PMCID: PMC7876161 DOI: 10.1007/s13187-020-01829-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Integrative oncology is a burgeoning field and typically provided by a multiprofessional team. To ensure cancer patients receive effective, appropriate, and safe care, health professionals providing integrative cancer care should have a certain set of competencies. The aim of this project was to define core competencies for different health professions involved in integrative oncology. The project consisted of two phases. A systematic literature review on published competencies was performed, and the results informed an international and interprofessional consensus procedure. The second phase consisted of three rounds of consensus procedure and included 28 experts representing 7 different professions (medical doctors, psychologists, nurses, naturopathic doctors, traditional Chinese medicine practitioners, yoga practitioners, patient navigators) as well as patient advocates, public health experts, and members of the Society for Integrative Oncology. A total of 40 integrative medicine competencies were identified in the literature review. These were further complemented by 18 core oncology competencies. The final round of the consensus procedure yielded 37 core competencies in the following categories: knowledge (n = 11), skills (n = 17), and abilities (n = 9). There was an agreement that these competencies are relevant for all participating professions. The integrative oncology core competencies combine both fundamental oncology knowledge and integrative medicine competencies that are necessary to provide effective and safe integrative oncology care for cancer patients. They can be used as a starting point for developing profession-specific learning objectives and to establish integrative oncology education and training programs to meet the needs of cancer patients and health professionals.
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Affiliation(s)
- Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, 8091, Zurich, Switzerland.
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany.
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Misha Cohen
- Chicken Soup Chinese Medicine, San Francisco, CA, USA
- American College of Traditional Chinese Medicine at California Institute of Integral Studies, San Francisco, CA, USA
| | - Gary Deng
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Anita Y Kinney
- Department of Epidemiology, School of Public Health and Rutgers, Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | | | - Laura Pole
- Smith Center for Healing and the Arts, Institute for Integrative Oncology Navigation, Washington, DC, USA
| | - Alizé A Rogge
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
| | - Carole O'Toole
- Smith Center for Healing and the Arts, Washington, DC, USA
| | - Suzanna M Zick
- Department of Family Medicine and Nutritional Sciences Schools of Medicine and Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Stefanie M Helmer
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
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O'Malley DM, Alfano CM, Doose M, Kinney AY, Lee SJC, Nekhlyudov L, Duberstein P, Hudson SV. Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research. Transl Behav Med 2021; 11:1989-1997. [PMID: 34850934 PMCID: PMC8634312 DOI: 10.1093/tbm/ibab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.
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Affiliation(s)
- Denalee M O'Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Catherine M Alfano
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anita Y Kinney
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Department of Population and Data Sciences, UT-Southwestern, Dallas, TX, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Brigham & Womens' Primary Care Medical Associates, Boston, MA, USA
| | - Paul Duberstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Northwell Health Cancer Institute, New Hyde Park, NY, USA.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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18
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Ford CG, Vowles KE, Smith BW, Kinney AY. Mindfulness and Meditative Movement Interventions for Men Living With Cancer: A Meta-analysis. Ann Behav Med 2021; 54:360-373. [PMID: 31773148 DOI: 10.1093/abm/kaz053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mindfulness-based interventions, Tai Chi/Qigong, and Yoga (defined here as meditative cancer interventions [MCIs]) have demonstrated small to medium effects on psychosocial outcomes in female breast cancer patients. However, no summary exists of how effective these interventions are for men with cancer. PURPOSE A meta-analysis was performed to determine the effectiveness of MCIs on psychosocial outcomes (e.g., quality of life, depression, and posttraumatic growth) for men with cancer. METHODS A literature search yielded 17 randomized controlled trials (N = 666) meeting study inclusion criteria. The authors were contacted to request data for male participants in the study when not reported. RESULTS With the removal of one outlier, there was a small effect found in favor of MCIs across all psychosocial outcomes immediately postintervention (g = .23, 95% confidence interval [CI] 0.02 to 0.44). Studies using a usual care control arm demonstrated a small effect in favor of MCIs (g = .26, 95% CI 0.10 to 0.42). However, there was insufficient evidence of a superior effect for MCIs when compared to an active control group, including attention control. Few studies examined both short-term and long-term outcomes. CONCLUSIONS There is evidence for MCIs improving psychosocial outcomes in male cancer survivors. However, this effect is not demonstrated when limited to studies that used active controls. The effect size found in this meta-analysis is smaller than those reported in MCI studies of mixed gender and female cancer patient populations. More rigorously designed randomized trials are needed that include active control groups, which control for attention, and long-term follow-up. There may be unique challenges for addressing the psychosocial needs of male cancer patients that future interventions should consider.
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Affiliation(s)
- C Graham Ford
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Bruce W Smith
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Anita Y Kinney
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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19
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Blair CK, Harding E, Wiggins C, Kang H, Schwartz M, Tarnower A, Du R, Kinney AY. A Home-Based Mobile Health Intervention to Replace Sedentary Time With Light Physical Activity in Older Cancer Survivors: Randomized Controlled Pilot Trial. JMIR Cancer 2021; 7:e18819. [PMID: 33847588 PMCID: PMC8087341 DOI: 10.2196/18819] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/14/2020] [Accepted: 03/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background Older cancer survivors are at risk of the development or worsening of both age- and treatment-related morbidity. Sedentary behavior increases the risk of or exacerbates these chronic conditions. Light-intensity physical activity (LPA) is more common in older adults and is associated with better health and well-being. Thus, replacing sedentary time with LPA may provide a more successful strategy to reduce sedentary time and increase physical activity. Objective This study primarily aims to evaluate the feasibility, acceptability, and preliminary efficacy of a home-based mobile health (mHealth) intervention to interrupt and replace sedentary time with LPA (standing and stepping). The secondary objective of this study is to examine changes in objective measures of physical activity, physical performance, and self-reported quality of life. Methods Overall, 54 cancer survivors (aged 60-84 years) were randomized in a 1:1:1 allocation to the tech support intervention group, tech support plus health coaching intervention group, or waitlist control group. Intervention participants received a Jawbone UP2 activity monitor for use with their smartphone app for 13 weeks. Tech support and health coaching were provided via 5 telephone calls during the 13-week intervention. Sedentary behavior and physical activity were objectively measured using an activPAL monitor for 7 days before and after the intervention. Results Participants included survivors of breast cancer (21/54, 39%), prostate cancer (16/54, 30%), and a variety of other cancer types; a mean of 4.4 years (SD 1.6) had passed since their cancer diagnosis. Participants, on average, were 70 years old (SD 4.8), 55% (30/54) female, 24% (13/54) Hispanic, and 81% (44/54) overweight or obese. Malfunction of the Jawbone trackers occurred in one-third of the intervention group, resulting in enrollment stopping at 54 rather than the initial goal of 60 participants. Despite these technical issues, the retention in the intervention was high (47/54, 87%). Adherence was high for wearing the tracker (29/29, 100%) and checking the app daily (28/29, 96%) but low for specific aspects related to the sedentary features of the tracker and app (21%-25%). The acceptability of the intervention was moderately high (81%). There were no significant between-group differences in total sedentary time, number of breaks, or number of prolonged sedentary bouts. There were no significant between-group differences in physical activity. The only significant within-group change occurred within the health coaching group, which increased by 1675 daily steps (95% CI 444-2906; P=.009). This increase was caused by moderate-intensity stepping rather than light-intensity stepping (+15.2 minutes per day; 95% CI 4.1-26.2; P=.008). Conclusions A home-based mHealth program to disrupt and replace sedentary time with stepping was feasible among and acceptable to older cancer survivors. Future studies are needed to evaluate the optimal approach for replacing sedentary behavior with standing and/or physical activity in this population. Trial Registration ClinicalTrials.gov NCT03632694; https://clinicaltrials.gov/ct2/show/NCT03632694
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Affiliation(s)
- Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Elizabeth Harding
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Charles Wiggins
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Huining Kang
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Matthew Schwartz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Amy Tarnower
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Ruofei Du
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, United States
| | - Anita Y Kinney
- School of Public Health, Rutgers University, Piscataway, NJ, United States.,Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States
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20
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Satagopan JM, Stroup A, Kinney AY, Dharamdasani T, Ganesan S, Bandera EV. Breast cancer among Asian Indian and Pakistani Americans: A surveillance, epidemiology and end results-based study. Int J Cancer 2020; 148:1598-1607. [PMID: 33099777 DOI: 10.1002/ijc.33331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/16/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/12/2022]
Abstract
Breast cancer incidence is increasing among Asian Indian and Pakistani women living in the United States. We examined the characteristics of breast cancer in Asian Indian and Pakistani American (AIPA) and non-Hispanic white (NHW) women using data from the surveillance, epidemiology and end results (SEER) program. Breast cancer incidence rates were estimated via segmented Poisson regression using data between 1990 and 2014 from SEER 9 registries, including New Jersey and California. Disease characteristics, treatment and survival information between 2000 and 2016 for 4900 AIPA and 482 250 NHW cases diagnosed after age 18 were obtained from SEER 18 registries and compared using descriptive analyses and multivariable competing risk proportional hazards regression. Breast cancer incidence was lower in AIPA than NHW women, increased with age and the rate of increase declined after age of 46 years. AIPA women were diagnosed at significantly younger age (mean (SD) = 54.5 (13.3) years) than NHW women (mean (SD) = 62 (14) years, P < .0001) and were more likely than NHW cases (P < .0001) to have regional or distant stage, higher grade, estrogen receptor-negative, progesterone receptor-negative, triple-negative or human epidermal growth factor receptor 2-enriched tumors, subcutaneous or total mastectomy, and lower cumulative incidence of death due to breast cancer (hazard ratio = 0.79, 95% CI: 0.72-0.86, P < .0001). AIPA had shorter median follow-up (52 months) than NHW cases (77 months). Breast cancer in AIPA women has unique characteristics that need to be further studied along with a comprehensive evaluation of their follow-up patterns.
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Affiliation(s)
- Jaya M Satagopan
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.,Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Antoinette Stroup
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.,Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.,New Jersey State Cancer Registry, State of New Jersey Department of Health, New Brunswick, New Jersey, USA
| | - Anita Y Kinney
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.,Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Tina Dharamdasani
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Shridar Ganesan
- Clinical Investigations and Precision Therapeutics Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Elisa V Bandera
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA.,Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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21
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Blair CK, Harding E, Herman C, Boyce T, Demark-Wahnefried W, Davis S, Kinney AY, Pankratz VS. Remote Assessment of Functional Mobility and Strength in Older Cancer Survivors: Protocol for a Validity and Reliability Study. JMIR Res Protoc 2020; 9:e20834. [PMID: 32769075 PMCID: PMC7492978 DOI: 10.2196/20834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Older cancer survivors, faced with both age- and treatment-related morbidity, are at increased and premature risk for physical function limitations. Physical performance is an important predictor of disability, quality of life, and premature mortality, and thus is considered an important target of interventions designed to prevent, delay, or attenuate the physical functional decline. Currently, low-cost, valid, and reliable methods to remotely assess physical performance tests that are self-administered by older adults in the home-setting do not exist, thus limiting the reach, scalability, and dissemination of interventions. OBJECTIVE This paper will describe the rationale and design for a study to evaluate the accuracy, reliability, safety, and acceptability of videoconferencing and self-administered tests of functional mobility and strength by older cancer survivors in their own homes. METHODS To enable remote assessment, participants receive a toolkit and instructions for setting up their test course and communicating with the investigator. Two standard gerontologic performance tests are being evaluated: the Timed Up and Go test and the 30-second chair stand test. Phase 1 of the study evaluates proof-of-concept that older cancer survivors (age ≥60 years) can follow the testing protocol and use a tablet PC to communicate with the study investigator. Phase 2 evaluates the criterion validity of videoconference compared to direct observation of the two physical performance tests. Phase 3 evaluates reliability by enrolling 5-10 participants who agree to repeat the remote assessment (without direct observation). Phase 4 enrolls 5-10 new study participants to complete the remote assessment test protocol. Feedback from participants in each phase is used to refine the test protocol and instructions. RESULTS Enrollment began in December 2019. Ten participants completed the Phase 1 proof-of-concept. The study was paused in mid-March 2020 due to the COVID-19 pandemic. The study is expected to be completed by the end of 2020. CONCLUSIONS This validity and reliability study will provide important information on the acceptability and safety of using videoconferencing to remotely assess two tests of functional mobility and strength, self-administered by older adults in their homes. Videoconferencing has the potential to expand the reach, scalability, and dissemination of interventions to older cancer survivors, and potentially other older adults, especially in rural areas. TRIAL REGISTRATION ClinicalTrials.gov NCT04339959; https://clinicaltrials.gov/ct2/show/NCT04339959. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20834.
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Affiliation(s)
- Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Elizabeth Harding
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Carla Herman
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Tawny Boyce
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sally Davis
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States.,Prevention Research Center, University of New Mexico, Albuquerque, NM, United States
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, United States.,Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States
| | - Vernon S Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
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22
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Ball J, Thompson J, Wulff-Burchfield E, Ellerbeck E, Kimminau K, Brooks JV, Petersen S, Rotich D, Kinney AY, Ellis SD. Precision community: a mixed methods study to identify determinants of adoption and implementation of targeted cancer therapy in community oncology. Implement Sci Commun 2020. [DOI: 10.1186/s43058-020-00064-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Precision medicine has enormous potential to improve cancer outcomes. Over one third of the 1.5 million Americans diagnosed with cancer each year have genetic mutations that could be targeted with an FDA-approved drug to treat their disease more effectively. However, the current uptake of targeted cancer therapy in clinical practice is suboptimal. Tumor testing is not widely used, and treatments based on molecular and genomic profiling are often not prescribed when indicated. Challenges with the uptake of precision medicine may disproportionately impact cancer patients in rural communities and other underserved populations. The objective of this study is to identify the determinants of adoption and implementation of precision cancer therapy to design an implementation strategy for community oncology practices, including those in rural areas.
Methods
This study is an explanatory sequential mixed methods study to identify factors associated with the use of targeted cancer therapy. Levels of targeted therapy use will be ascertained by secondary analysis of medical records to identify concordance with 18 national guideline recommendations for use of precision medicine in the treatment of breast, colorectal, lung, and melanoma skin cancer. Concurrently, facilitators and barriers associated with the use of precision cancer therapy will be elicited from interviews with up to a total of 40 oncologists, administrators, pathology, and pharmacy staff across the participating sites. Qualitative analysis will be a template analysis based on the Theoretical Domains Framework. Quantitative data aggregated at the practice level will be used to rank oncology practices’ adherence to targeted cancer therapy guidelines. Determinants will be compared among high and low users to isolate factors likely to facilitate targeted therapy use. The study will be conducted in eight community oncology practices, with an estimated 4121 targeted therapy treatment decision-making opportunities over a 3-year period.
Discussion
Despite unprecedented investment in precision medicine, translation into practice is suboptimal. Our study will identify factors associated with the uptake of precision medicine in community settings. These findings will inform future interventions to increase equitable uptake of evidence-based targeted cancer treatment.
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23
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Pinto NM, Henry KA, Grobman WA, Ness A, Miller S, Ellestad S, Gotteiner N, Tacy T, Wei G, Minich LL, Kinney AY. Physician Barriers and Facilitators for Screening for Congenital Heart Disease With Routine Obstetric Ultrasound: A National United States Survey. J Ultrasound Med 2020; 39:1143-1153. [PMID: 31875341 PMCID: PMC7357993 DOI: 10.1002/jum.15199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/06/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Prenatal detection of congenital heart disease with obstetric screening remains at less than 50% in most population studies, far from what is thought to be achievable. We sought to identify barriers/facilitators for screening from the perspective of interpreting physicians and to understand how these barriers/facilitators may be associated with interpretation of screening images. METHODS Our mixed-methods studies included 4 focus groups in centers across the United States with obstetric, maternal-fetal medicine, and radiology providers who interpreted obstetric ultrasound studies. Themes around barriers/facilitators for fetal heart screening were coded from transcripts. A national Web-based survey was then conducted, which quantitatively measured reported barriers/facilitators and measured physicians' ability to interpret fetal heart-screening images. Multivariable generalized linear random-effect models assessed the association between barriers/facilitators and the accuracy of image interpretation at the image level. RESULTS Three main themes were identified in the focus groups: intrinsic barriers (ie, comfort with screening), external barriers (ie, lack of feedback), and organizational barriers (ie, study volumes). Among 190 physician respondents, 104 interpreted ultrasound studies. Perceptions of barriers varied by practice setting, with nontertiary providers having lower self-efficacy and perceived usefulness of cardiac screening. Facilitators associated with the odds of accurate interpretation of screening images were knowledge (odds ratio, 2.54; P = .002) and the volume of scans per week (odds ratio, 1.01 for every additional scan; P = .04). CONCLUSIONS Some of the main barriers to cardiac screening identified and prioritized by physicians across the United States were knowledge of screening and minimal volumes of scans. Targeting these barriers will aid in improving prenatal detection of congenital heart disease.
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Affiliation(s)
- Nelangi M Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amen Ness
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Stephen Miller
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Ellestad
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nina Gotteiner
- Division of Pediatric Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Theresa Tacy
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Guo Wei
- Division of Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - L LuAnn Minich
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, and Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey, USA
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24
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Kalke K, Ginossar T, Bentley JM, Carver H, Shah SFA, Kinney AY. Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis. JMIR Mhealth Uhealth 2020; 8:e14082. [PMID: 32012084 PMCID: PMC7007595 DOI: 10.2196/14082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/22/2019] [Accepted: 08/31/2019] [Indexed: 12/29/2022] Open
Abstract
Background Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. Objective Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. Methods Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. Results The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. Conclusions Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum.
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Affiliation(s)
- Kerstin Kalke
- Department of Communication Studies, Northwestern University, Evanston, IL, United States
| | - Tamar Ginossar
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, United States
| | - Joshua M Bentley
- Department of Strategic Communication, Texas Christian University, Fort Worth, TX, United States
| | - Hannah Carver
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Sayyed Fawad Ali Shah
- Department of Communication, Jacksonville State University, Jacksonville, AL, United States
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, New Brunswick, NJ, United States.,Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States
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25
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Blair CK, McDougall JA, Chiu VK, Wiggins CL, Rajput A, Harding EM, Kinney AY. Correlates of poor adherence to a healthy lifestyle among a diverse group of colorectal cancer survivors. Cancer Causes Control 2019; 30:1327-1339. [PMID: 31655944 DOI: 10.1007/s10552-019-01241-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/07/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Lifestyle factors may have a synergistic effect on health. We evaluated the correlates of poor adherence to a healthy lifestyle among a diverse sample of colorectal cancer (CRC) survivors to inform future lifestyle promotion programs. METHODS Lifestyle questions from a cross-sectional survey were completed by 283 CRC survivors (41% Hispanic, 40% rural, 33% low income). Adherence to recommendations (yes/no) for physical activity, fruit and vegetable servings/day, avoiding tobacco, and healthy weight was summed to create an overall lifestyle quality score. Polytomous logistic regression was used to evaluate correlates of good (reference group), moderate, and poor overall lifestyle quality. Potential correlates included sociodemographic characteristics, cancer-related factors, and indicators of health and well-being. RESULTS CRC survivors with poor adherence were 2- to 3.4-fold significantly more likely to report multiple comorbidities, poor physical functioning, fatigue, anxiety/depressive symptoms, and poor social participation. In multivariable analyses, poor physical functioning was the only significant correlate of poor adherence to lifestyle recommendations, compared to good adherence [OR (95% CI) 3.4 (1.8-6.4)]. The majority of survivors, 71% and 78%, indicated interest in receiving information on exercise and eating a healthy diet, respectively. CONCLUSION Future lifestyle promotion programs for CRC survivors should carefully consider indicators of physical and psychosocial health and well-being, especially poor physical functioning, in the design, recruitment, and implementation of these health programs.
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Affiliation(s)
- Cindy K Blair
- Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, 87131-0001, USA. .,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
| | - Jean A McDougall
- Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, 87131-0001, USA.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Vi K Chiu
- Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, 87131-0001, USA.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Charles L Wiggins
- Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, 87131-0001, USA.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Ashwani Rajput
- Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, 87131-0001, USA.,Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth M Harding
- Department of Health, Exercise, and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Anita Y Kinney
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, NJ, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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26
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Himes DO, Davis SH, Lassetter JH, Peterson NE, Clayton MF, Birmingham WC, Kinney AY. Does family communication matter? Exploring knowledge of breast cancer genetics in cancer families. J Community Genet 2019; 10:481-487. [PMID: 30877488 PMCID: PMC6754477 DOI: 10.1007/s12687-019-00413-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/28/2019] [Indexed: 12/24/2022] Open
Abstract
Knowledge of breast cancer genetics is critical for those at increased hereditary risk who must make decisions about breast cancer screening options. This descriptive study explored theory-based relationships among cognitive and emotional variables related to knowledge of breast cancer genetics in cancer families. Participants included first-degree relatives of women with breast cancer who had received genetic counseling and testing. Study participants themselves did not have breast cancer and had not received genetic counseling or testing. Data were collected by telephone interviews and surveys. Variables analyzed included numeracy, health literacy, cancer-related distress, age, education, and the reported amount of information shared by the participants' family members about genetic counseling. The multiple regression model explained 13.9% of variance in knowledge of breast cancer genetics (p = 0.03). Best fit of the multiple regression model included all variables except education. Reported amount of information shared was the only independently significant factor associated with knowledge (β = 0.28, p = 0.01). Participants who reported higher levels of information shared by a family member about information learned during a genetic counseling session also demonstrated increased knowledge about breast cancer genetics.
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Affiliation(s)
- Deborah O Himes
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA.
| | - Sarah H Davis
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Jane H Lassetter
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Neil E Peterson
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Margaret F Clayton
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Wendy C Birmingham
- Department of Psychology, Brigham Young University, 1054 Spencer W. Kimball Tower, Provo, UT, 84604, USA
| | - Anita Y Kinney
- Department of Epidemiology - School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
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27
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Kinney AY, Blair CK, Guest DD, Ani JK, Harding EM, Amorim F, Boyce T, Rodman J, Ford CG, Schwartz M, Rosenberg L, Foran O, Gardner J, Lin Y, Arap W, Irwin MR. Biobehavioral effects of Tai Chi Qigong in men with prostate cancer: Study design of a three-arm randomized clinical trial. Contemp Clin Trials Commun 2019; 16:100431. [PMID: 31650067 PMCID: PMC6804681 DOI: 10.1016/j.conctc.2019.100431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/02/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022] Open
Abstract
Fatigue is often one of the most commonly reported symptoms in prostate cancer survivors, but it is also one of the least understood cancer-related symptoms. Fatigue is associated with psychological distress, disruptions in sleep quality, and impairments in health-related quality of life. Moreover, inflammatory processes and changes related to the hypothalamic-pituitary-adrenal (HPA) axis and/or autonomic nervous system may also play a role in cancer-related fatigue. Thus, effective treatments for fatigue in prostate cancer survivors represent a current unmet need. Prior research has shown that Tai Chi Qigong, a mind-body exercise intervention, can improve physical and emotional health. Herein, we describe the protocol of the ongoing 3-arm randomized controlled Health Empowerment & Recovery Outcomes (HERO) clincal trial. One hundred sixty-six prostate cancer survivors with fatigue are randomized to a modified Tai Chi Qigong intervention (TCQ), intensity-matched body training intervention (BT), or usual care (UC) condition. Guided by biopsychosocial and psychoneuroimmunology models, we propose that TCQ, as compared to BT or UC will: i) reduce fatigue (primary outcome) in prostate cancer survivors; ii) reduce inflammation; and iii) regulate the expression of genes from two major functional clusters: a) inflammation, vasodilation and metabolite sensing and b) energy and adrenergic activation. Assessments are conducted at baseline, the 6-week midpoint of the intervention, and 1 week, 3 months, and 12 months post-intervention. If our findings show that TCQ promotes recovery from prostate cancer and its treatment, this type of intervention can be integrated into survivorship care plans as the standard of care. The study's findings will also provide novel information about underlying biobehavioral mechanisms of cancer-related fatigue. Trial registration number NCT03326713; clinicaltrials.gov.
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Affiliation(s)
- Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Dolores D Guest
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Julianne K Ani
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Fabiano Amorim
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Tawny Boyce
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - C Graham Ford
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Matthew Schwartz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | | | - Olivia Foran
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jerry Gardner
- Department of Theatre, University of Utah, Salt Lake City, UT, USA
| | - Yong Lin
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Wadih Arap
- Division of Hematology/Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.,Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neurosciences, University of California Los Angeles, California, USA.,Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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28
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Pinto NM, Henry KA, Wei G, Sheng X, Green T, Puchalski MD, Byrne JLB, Kinney AY. Barriers to Sonographer Screening for Fetal Heart Defects: A U.S. National Survey. Fetal Diagn Ther 2019; 47:188-197. [PMID: 31416072 DOI: 10.1159/000501430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/04/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We surveyed obstetric sonographers, who are at the forefront of the screening process to determine how barriers to prenatal cardiac screening impacted screening abilities. METHODS We performed a cross-sectional national survey of obstetric sonographers in the United States using a sampling frame from American Registry of Diagnostic Medical Sonography mailing lists. The web survey measured the ability to obtain and interpret fetal heart images. Several cognitive, sociodemographic, and system-level factors were measured, including intention to perform cardiac imaging. Regression and mediation analyses determined factors associated with intention to perform and ability to obtain and interpret cardiac images. Subgroup analyses of sonographers in tertiary versus nontertiary centers were also performed. RESULTS Survey response rate either due to noncontact or nonresponse was 40%. Of 480 eligible sonographers, ~30% practiced in tertiary settings. Sonographers had lower intention to perform outflow views compared to 4 chambers. Higher self-efficacy and professional expectations predicted higher odds of intention to perform outflow views (OR 2.8, 95% CI 1.9-4.2 and 1.9, 95% CI 1.1-3.0, respectively). Overall accuracy of image interpretation was 65% (±14%). For the overall cohort and nontertiary subgroup, higher intention to perform outflows was associated with increased accuracy in overall image interpretation. For the tertiary subgroup, self-efficacy and feedback were strongly associated with accuracy. CONCLUSIONS We identified several modifiable (some heretofore unrecognized) targets to improve prenatal cardiac screening. Priorities identified by sonographers that are associated with screening success should guide future interventions.
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Affiliation(s)
- Nelangi M Pinto
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, Utah, USA,
| | - Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania, USA
| | - Guo Wei
- Department of Pediatrics, Division of Biostatistics, University of Utah, Salt Lake City, Utah, USA
| | - Xiaoming Sheng
- Department of Pediatrics, Division of Biostatistics, University of Utah, Salt Lake City, Utah, USA
| | - Tom Green
- Department of Pediatrics, Division of Biostatistics, University of Utah, Salt Lake City, Utah, USA
| | - Michael D Puchalski
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, Utah, USA
| | - Janice L B Byrne
- Department of Internal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Anita Y Kinney
- School of Public Health and Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey, USA
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29
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Himes DO, Gibbons DK, Birmingham WC, Beckstrand RL, Gammon A, Kinney AY, Clayton MF. Female family members lack understanding of indeterminate negative BRCA1/2 test results shared by probands. J Genet Couns 2019; 28:950-961. [PMID: 31199558 DOI: 10.1002/jgc4.1147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/04/2018] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 11/10/2022]
Abstract
Genetic test results have important implications for close family members. Indeterminate negative results are the most common outcome of BRCA1/2 mutation testing. Little is known about family members' understanding of indeterminate negative BRCA1/2 test results. The purpose of this mixed-methods study was to investigate how daughters and sisters received and understood genetic test results as shared by their mothers or sisters. Participants included 81 women aged 40-74 with mothers or sisters previously diagnosed with breast cancer and who received indeterminate negative BRCA1/2 test results. Participants had never been diagnosed with breast cancer nor received their own genetic testing or counseling. This Institutional Review Board-approved study utilized semi-structured interviews and surveys. Descriptive coding with theme development was used during qualitative analysis. Participants reported low amounts of information shared with them. Most women described test results as negative and incorrectly interpreted the test to mean there was no genetic component to the pattern of cancer in their families. Only seven of 81 women accurately described test results consistent with the meaning of an indeterminate negative. Our findings demonstrate that indeterminate negative genetic test results are not well understood by family members. Lack of understanding may lead to an inability to effectively communicate results to primary care providers and missed opportunities for prevention, screening, and further genetic testing. Future research should evaluate acceptability and feasibility of providing family members letters they can share with their own primary care providers.
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Affiliation(s)
| | | | | | | | - Amanda Gammon
- Department of Genetic Counseling, Huntsman Cancer Institute, Salt Lake City, Utah.,Graduate Program in Genetic Counseling, University of Utah, Salt Lake City, Utah
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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30
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McDougall JA, Blair CK, Wiggins CL, Goodwin MB, Chiu VK, Rajput A, Kinney AY. Socioeconomic disparities in health-related quality of life among colorectal cancer survivors. J Cancer Surviv 2019; 13:459-467. [PMID: 31111302 DOI: 10.1007/s11764-019-00767-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 06/28/2018] [Accepted: 05/10/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Improvements in colorectal cancer (CRC) prevention, early detection, and treatment have resulted in substantial gains in survival. However, the health-related quality of life (HRQoL) of CRC survivors often depends on access to supportive care, which differs by survivors' socioeconomic characteristics. The purpose of this study was to investigate the relationship between socioeconomic characteristics and HRQoL in a diverse group of CRC survivors. METHODS We conducted a population-based, cross-sectional study to examine the association between socioeconomic factors (household income, health literacy, and insurance status) and HRQoL domains of pain interference, fatigue, physical function, sleep disturbance, anxiety, and depression. PROMIS® Short Forms v.2.0 were used to assess domains of HRQoL. Linear regression modeling was used to estimate the coefficient representing the average HRQoL domain score and its 95% confidence interval (CI). RESULTS Three hundred one CRC survivors participated in the survey. Low-income (≤ $30,000) CRC survivors had, on average, a 4.70-point (95% CI 1.10-8.28) higher pain interference score, a 7.02-point (95% CI 3.27-10.77) higher fatigue score, a 5.13-point (95% CI - 8.56 to - 1.71) lower physical function score, and a 4.44-point (95% 1.40-7.49) higher depression score than CRC survivors with an income ≥ $70,000. Survivors with Medicaid insurance reported significantly greater pain interference and worse physical function than privately insured survivors. Survivors with low health literacy reported significantly greater pain interference compared with survivors with high health literacy. CONCLUSIONS Substantial socioeconomic disparities in HRQoL were observed in this diverse population of CRC survivors. IMPLICATIONS FOR CANCER SURVIVORS Designing supportive care interventions to improve HRQoL among low-income and Medicaid-insured CRC survivors is critical for eliminating disparities in CRC outcomes.
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Affiliation(s)
- Jean A McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA. .,Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA. .,University of New Mexico, MSC105550, Albuquerque, NM, 87131-0001, USA.
| | - Cindy K Blair
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Michael B Goodwin
- Department of Economics, University of New Mexico, Albuquerque, NM, USA
| | - Vi K Chiu
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Ashwani Rajput
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Anita Y Kinney
- Rutgers, School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
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31
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Millar MM, Kinney AY, Camp NJ, Cannon-Albright LA, Hashibe M, Penson DF, Kirchhoff AC, Neklason DW, Gilsenan AW, Dieck GS, Stroup AM, Edwards SL, Bateman C, Carter ME, Sweeney C. Predictors of Response Outcomes for Research Recruitment Through a Central Cancer Registry: Evidence From 17 Recruitment Efforts for Population-Based Studies. Am J Epidemiol 2019. [PMID: 30689685 DOI: 10.1093/aje/kwz011:10.1093/aje/kwz011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
When recruiting research participants through central cancer registries, high response fractions help ensure population-based representation. We conducted multivariable mixed-effects logistic regression to identify case and study characteristics associated with making contact with and obtaining cooperation of Utah cancer cases using data from 17 unique recruitment efforts undertaken by the Utah Cancer Registry (2007-2016) on behalf of the following studies: A Population-Based Childhood Cancer Survivors Cohort Study in Utah, Comparative Effectiveness Analysis of Surgery and Radiation for Prostate Cancer (CEASAR Study), Costs and Benefits of Follow-up Care for Adolescent and Young Adult Cancers, Study of Exome Sequencing for Head and Neck Cancer Susceptibility Genes, Genetic Epidemiology of Chronic Lymphocytic Leukemia, Impact of Remote Familial Colorectal Cancer Risk Assessment and Counseling (Family CARE Project), Massively Parallel Sequencing for Familial Colon Cancer Genes, Medullary Thyroid Carcinoma (MTC) Surveillance Study, Osteosarcoma Surveillance Study, Prostate Cancer Outcomes Study, Risk Education and Assessment for Cancer Heredity Project (REACH Project), Study of Shared Genomic Segment Analysis and Tumor Subtyping in High-Risk Breast-Cancer Gene Pedigrees, Study of Shared Genomic Segment Analysis for Localizing Multiple Myeloma Genes. Characteristics associated with lower odds of contact included Hispanic ethnicity (odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.27, 0.41), nonwhite race (OR = 0.46, 95% CI: 0.35, 0.60), and younger age at contact. Years since diagnosis was inversely associated with making contact. Nonwhite race and age ≥60 years had lower odds of cooperation. Study features with lower odds of cooperation included longitudinal design (OR = 0.50, 95% CI: 0.41, 0.61) and study brochures (OR = 0.70, 95% CI: 0.54, 0.90). Increased odds of cooperation were associated with including a questionnaire (OR = 3.19, 95% CI: 1.54, 6.59), postage stamps (OR = 1.60, 95% CI: 1.21, 2.12), and incentives (OR = 1.62, 95% CI: 1.02, 2.57). Among cases not responding after the first contact, odds of eventual response were lower when >10 days elapsed before subsequent contact (OR = 0.71, 95% CI: 0.59, 0.85). Obtaining high response is challenging, but study features identified in this analysis support better results when recruiting through central cancer registries.
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Affiliation(s)
- Morgan M Millar
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.,Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, Rutgers Health, Rutgers University, New Brunswick, New Jersey
| | - Nicola J Camp
- Division of Hematology and Hematological Malignancies, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Lisa A Cannon-Albright
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Mia Hashibe
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah.,Division of Public Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - David F Penson
- Urologic Surgery, Department of Urology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee.,Center for Surgical Quality and Outcomes Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah.,Division of Pediatric Hematology and Oncology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Deborah W Neklason
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Alicia W Gilsenan
- Department of Epidemiology, RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
| | - Gretchen S Dieck
- Safety, Epidemiology, and Risk Management, United BioSource Corporation, Blue Bell, Pennsylvania
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers Health, Rutgers University, New Brunswick, New Jersey.,Division of Cancer Epidemiology, Rutgers School of Public Health, Rutgers University, New Brunswick, New Jersey.,New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, New Jersey
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Carrie Bateman
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Carol Sweeney
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah.,Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah.,Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
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Millar MM, Kinney AY, Camp NJ, Cannon-Albright LA, Hashibe M, Penson DF, Kirchhoff AC, Neklason DW, Gilsenan AW, Dieck GS, Stroup AM, Edwards SL, Bateman C, Carter ME, Sweeney C. Predictors of Response Outcomes for Research Recruitment Through a Central Cancer Registry: Evidence From 17 Recruitment Efforts for Population-Based Studies. Am J Epidemiol 2019; 188:928-939. [PMID: 30689685 DOI: 10.1093/aje/kwz011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/29/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/24/2022] Open
Abstract
When recruiting research participants through central cancer registries, high response fractions help ensure population-based representation. We conducted multivariable mixed-effects logistic regression to identify case and study characteristics associated with making contact with and obtaining cooperation of Utah cancer cases using data from 17 unique recruitment efforts undertaken by the Utah Cancer Registry (2007-2016) on behalf of the following studies: A Population-Based Childhood Cancer Survivors Cohort Study in Utah, Comparative Effectiveness Analysis of Surgery and Radiation for Prostate Cancer (CEASAR Study), Costs and Benefits of Follow-up Care for Adolescent and Young Adult Cancers, Study of Exome Sequencing for Head and Neck Cancer Susceptibility Genes, Genetic Epidemiology of Chronic Lymphocytic Leukemia, Impact of Remote Familial Colorectal Cancer Risk Assessment and Counseling (Family CARE Project), Massively Parallel Sequencing for Familial Colon Cancer Genes, Medullary Thyroid Carcinoma (MTC) Surveillance Study, Osteosarcoma Surveillance Study, Prostate Cancer Outcomes Study, Risk Education and Assessment for Cancer Heredity Project (REACH Project), Study of Shared Genomic Segment Analysis and Tumor Subtyping in High-Risk Breast-Cancer Gene Pedigrees, Study of Shared Genomic Segment Analysis for Localizing Multiple Myeloma Genes. Characteristics associated with lower odds of contact included Hispanic ethnicity (odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.27, 0.41), nonwhite race (OR = 0.46, 95% CI: 0.35, 0.60), and younger age at contact. Years since diagnosis was inversely associated with making contact. Nonwhite race and age ≥60 years had lower odds of cooperation. Study features with lower odds of cooperation included longitudinal design (OR = 0.50, 95% CI: 0.41, 0.61) and study brochures (OR = 0.70, 95% CI: 0.54, 0.90). Increased odds of cooperation were associated with including a questionnaire (OR = 3.19, 95% CI: 1.54, 6.59), postage stamps (OR = 1.60, 95% CI: 1.21, 2.12), and incentives (OR = 1.62, 95% CI: 1.02, 2.57). Among cases not responding after the first contact, odds of eventual response were lower when >10 days elapsed before subsequent contact (OR = 0.71, 95% CI: 0.59, 0.85). Obtaining high response is challenging, but study features identified in this analysis support better results when recruiting through central cancer registries.
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Affiliation(s)
- Morgan M Millar
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, New Brunswick, New Jersey
- Rutgers Cancer Institute of New Jersey, Rutgers Health, Rutgers University, New Brunswick, New Jersey
| | - Nicola J Camp
- Division of Hematology and Hematological Malignancies, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Lisa A Cannon-Albright
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Mia Hashibe
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - David F Penson
- Urologic Surgery, Department of Urology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
- Center for Surgical Quality and Outcomes Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Deborah W Neklason
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Alicia W Gilsenan
- Department of Epidemiology, RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
| | - Gretchen S Dieck
- Safety, Epidemiology, and Risk Management, United BioSource Corporation, Blue Bell, Pennsylvania
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers Health, Rutgers University, New Brunswick, New Jersey
- Division of Cancer Epidemiology, Rutgers School of Public Health, Rutgers University, New Brunswick, New Jersey
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, New Jersey
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Carrie Bateman
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Carol Sweeney
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
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Kinney AY, Howell R, Ruckman R, McDougall JA, Boyce TW, Vicuña B, Lee JH, Guest DD, Rycroft R, Valverde PA, Gallegos KM, Meisner A, Wiggins CL, Stroup A, Paddock LE, Walters ST. Promoting guideline-based cancer genetic risk assessment for hereditary breast and ovarian cancer in ethnically and geographically diverse cancer survivors: Rationale and design of a 3-arm randomized controlled trial. Contemp Clin Trials 2018; 73:123-135. [PMID: 30236776 PMCID: PMC6214814 DOI: 10.1016/j.cct.2018.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/27/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although national guidelines for cancer genetic risk assessment (CGRA) for hereditary breast and ovarian cancer (HBOC) have been available for over two decades, less than half of high-risk women have accessed these services, especially underserved minority and rural populations. Identification of high-risk individuals is crucial for cancer survivors and their families to benefit from biomedical advances in cancer prevention, early detection, and treatment. METHODS This paper describes community-engaged formative research and the protocol of the ongoing randomized 3-arm controlled Genetic Risk Assessment for Cancer Education and Empowerment (GRACE) trial. Ethnically and geographically diverse breast and ovarian cancer survivors at increased risk for hereditary cancer predisposition who have not had a CGRA are recruited through the three statewide cancer registries. The specific aims are to: 1) compare the effectiveness of a targeted intervention (TP) vs. a tailored counseling and navigation(TCN) intervention vs. usual care (UC) on CGRA utilization at 6 months post-diagnosis (primary outcome); compare the effectiveness of the interventions on genetic counseling uptake at 12 months after removal of cost barriers (secondary outcome); 2) examine potential underlying theoretical mediating and moderating mechanisms; and 3) conduct a cost evaluation to guide dissemination strategies. DISCUSSION The ongoing GRACE trial addresses an important translational gap by developing and implementing evidence-based strategies to promote guideline-based care and reduce disparities in CGRA utilization among ethnically and geographically diverse women. If effective, these interventions have the potential to reach a large number of high-risk families and reduce disparities through broad dissemination. TRIAL REGISTRATION NUMBER NCT03326713; clinicaltrials.gov.
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Affiliation(s)
- Anita Y Kinney
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey.
| | - Rachel Howell
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Rachel Ruckman
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Jean A McDougall
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Tawny W Boyce
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Belinda Vicuña
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico; Department of Psychology, University of New Mexico, Albuquerque, Mexico
| | - Ji-Hyun Lee
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Dolores D Guest
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico
| | - Randi Rycroft
- Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, Denver, CO, United States
| | - Patricia A Valverde
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | - Angela Meisner
- New Mexico Tumor Registry, University of New Mexico, Albuquerque, Mexico
| | - Charles L Wiggins
- Department of Internal Medicine, University of New Mexico, Albuquerque, Mexico; Comprehensive Cancer Center, University of New Mexico, Albuquerque, Mexico; New Mexico Tumor Registry, University of New Mexico, Albuquerque, Mexico
| | - Antoinette Stroup
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey
| | - Lisa E Paddock
- Department of Epidemiology, School of Public Health, Rutgers University, New Brunswick, Jersey; Cancer Institute of New Jersey, Rutgers University, New Brunswick, Jersey
| | - Scott T Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX, United States
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McDougall JA, Banegas MP, Wiggins C, Rajput A, Chiu VK, Flores KG, Kinney AY. Abstract C52: Disparities in treatment-related financial hardship and adherence to surveillance colonoscopy guidelines in ethnically, linguistically, and geographically diverse colorectal cancer survivors. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-c52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Cancer survivors increasingly report financial hardship as a consequence of the high cost of cancer care, yet the financial experience of traditionally underserved patients, including racial/ethnic minorities, non-English speakers, and rural residents, remains largely unstudied. The purpose of this study was to investigate potential disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy.
Methods: In this cross-sectional study, individuals diagnosed with localized or regional colorectal cancer between 2004-2012 were ascertained by the population-based New Mexico Tumor Registry. Participants completed a mailed questionnaire or telephone survey about their cancer survivorship experience, including treatment-related financial hardship and receipt of surveillance colonoscopy. Participants were considered to have experienced treatment-related financial hardship if they reported any debt accumulation, bankruptcy filing, other financial sacrifices, or inability to pay medical bills as a consequence of their illness, its treatment, or its lasting effects. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI).
Results: In this sample of 277 colorectal cancer survivors, 44% of participants reported financial hardship. Individuals with low health literacy (OR 5.41, 95% CI 1.45-20.1), Spanish-speaking Hispanics (OR 3.09, 95% CI 1.39-6.87), divorced, separated or single survivors (OR 1.94, 95% CI 1.94, 95% CI 1.06-3.54), and rural residents (OR 1.86, 95% CI 1.06-3.28) were more likely to report financial hardship. Nonadherence to surveillance colonoscopy guidelines was two times as likely among participants reporting financial hardship (OR 2.17 95% CI 1.01-4.67) and among rural residents (OR 2.28, 95% CI 1.07-4.48) than those reporting no financial hardship and urban residents, respectively.
Conclusions: Substantial disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy exist. Identifying patients at risk of financial hardship and developing interventions to reduce the financial burden of cancer may improve adherence to surveillance recommendations.
Citation Format: Jean A. McDougall, Matthew P. Banegas, Charles Wiggins, Ashwani Rajput, Vi K. Chiu, Kristina G. Flores, Anita Y. Kinney. Disparities in treatment-related financial hardship and adherence to surveillance colonoscopy guidelines in ethnically, linguistically, and geographically diverse colorectal cancer survivors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C52.
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Affiliation(s)
| | | | | | | | - Vi K. Chiu
- 1University of New Mexico, Albuquerque, NM,
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Harding E, Tarnower A, Wiggins C, Williams E, Schwartz M, Medrano D, Kinney AY, Blair CK. Intervention Targeting Reductions In Sedentary Time In Older Cancer Survivors. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538353.51502.5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McDougall JA, Banegas MP, Wiggins CL, Chiu VK, Rajput A, Kinney AY. Rural Disparities in Treatment-Related Financial Hardship and Adherence to Surveillance Colonoscopy in Diverse Colorectal Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2018; 27:1275-1282. [PMID: 29593011 DOI: 10.1158/1055-9965.epi-17-1083] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/08/2018] [Accepted: 03/05/2018] [Indexed: 01/08/2023] Open
Abstract
Background: Cancer survivors increasingly report financial hardship as a consequence of the high cost of cancer care, yet the financial experience of rural cancer survivors remains largely unstudied. The purpose of this study was to investigate potential rural disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy.Methods: Individuals diagnosed with localized or regional colorectal cancer between 2004 and 2012 were ascertained by the population-based New Mexico Tumor Registry. Participants completed a mailed questionnaire or telephone survey about their colorectal cancer survivorship experience, including treatment-related financial hardship and receipt of surveillance colonoscopy. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).Results: Compared with urban colorectal cancer survivors (n = 168), rural colorectal cancer survivors (n = 109) were slightly older; more likely to be married (65% vs. 59%) and have an annual income <$30,000 (37% vs. 27%); and less likely to be employed (35% vs. 41%), have a college degree (28% vs. 38%), or a high level of health literacy (39% vs. 51%). Rural survivors were twice as likely as urban survivors to report treatment-related financial hardship (OR, 1.86; 95% CI, 1.06-3.28) and nonadherence to surveillance colonoscopy guidelines (OR, 2.28; 95% CI, 1.07-4.85). In addition, financial hardship was independently associated with nonadherence to surveillance colonoscopy (OR, 2.17; 95% CI, 1.01-4.85).Conclusions: Substantial rural disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy exist.Impact: Treatment-related financial hardship among rural colorectal cancer survivors may negatively affect adherence to guideline-recommended follow-up care. Cancer Epidemiol Biomarkers Prev; 27(11); 1275-82. ©2018 AACR.
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Affiliation(s)
- Jean A McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. .,University of New Mexico School of Medicine, Department of Internal Medicine, Albuquerque, New Mexico
| | | | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,University of New Mexico School of Medicine, Department of Internal Medicine, Albuquerque, New Mexico
| | - Vi K Chiu
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,University of New Mexico School of Medicine, Department of Internal Medicine, Albuquerque, New Mexico
| | - Ashwani Rajput
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,University of New Mexico School of Medicine, Department of Surgery, Albuquerque, New Mexico
| | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,University of New Mexico School of Medicine, Department of Internal Medicine, Albuquerque, New Mexico
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Puri S, Hyland KA, Weiss KC, Bell GC, Gray JE, Kim R, Lin HY, Hoogland AI, Gonzalez BD, Nelson AM, Kinney AY, Fischer SM, Li D, Jacobsen PB, McLeod HL, Jim HSL. Prediction of chemotherapy-induced nausea and vomiting from patient-reported and genetic risk factors. Support Care Cancer 2018; 26:2911-2918. [PMID: 29546524 DOI: 10.1007/s00520-018-4120-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/13/2017] [Accepted: 02/20/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) is common among cancer patients. Early identification of patients at risk for CINV may help to personalize anti-emetic therapies. To date, few studies have examined the combined contributions of patient-reported and genetic risk factors to CINV. The goal of this study was to evaluate these risk factors. METHODS Prior to their first chemotherapy infusion, participants completed demographic and risk factor questionnaires and provided a blood sample to measure genetic variants in ABCB1 (rs1045642) and HTR3B (rs45460698) as well as CYP2D6 activity score. The M.D. Anderson Symptom Inventory was completed at 24 h and 5-day post-infusion to assess the severity of acute and delayed CINV, respectively. RESULTS Participants were 88 patients (55% female, M = 60 years). A total of 23% experienced acute nausea and 55% delayed nausea. Younger age, history of pregnancy-related nausea, fewer hours slept the night prior to infusion, and variation in ABCB1 were associated with more severe acute nausea; advanced-stage cancer and receipt of highly emetogenic chemotherapy were associated with more severe delayed nausea (p values < 0.05). In multivariable analyses, ABCB1 added an additional 5% predictive value beyond the 13% variance explained by patient-reported risk factors. CONCLUSIONS The current study identified patient-reported and genetic factors that may place patients at risk for acute nausea despite receipt of guideline-consistent anti-emetic prophylaxis. Additional studies examining other genetic variants are needed, as well as the development of risk prediction models including both patient-reported and genetic risk factors.
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Affiliation(s)
- Sonam Puri
- Department of Hematology and Oncology, Moffitt Cancer Center, Tampa, FL, USA.,College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kelly A Hyland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-SCM, Tampa, FL, 33612, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Kristine Crowe Weiss
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-SCM, Tampa, FL, 33612, USA
| | - Gillian C Bell
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jhanelle E Gray
- Department of Hematology and Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Richard Kim
- Department of Hematology and Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Hui-Yi Lin
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-SCM, Tampa, FL, 33612, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-SCM, Tampa, FL, 33612, USA
| | - Ashley M Nelson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-SCM, Tampa, FL, 33612, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Anita Y Kinney
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Stacy M Fischer
- Division of General Internal Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Howard L McLeod
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-SCM, Tampa, FL, 33612, USA.
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Vicuña B, Delaney HD, Flores KG, Ballinger L, Royce M, Dayao Z, Pal T, Kinney AY. Preferences for multigene panel testing for hereditary breast cancer risk among ethnically diverse BRCA-uninformative families. J Community Genet 2018; 9:81-92. [PMID: 28971318 PMCID: PMC5752653 DOI: 10.1007/s12687-017-0322-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/04/2017] [Indexed: 12/21/2022] Open
Abstract
Until recently, genetic testing for hereditary breast cancer has primarily focused on pathogenic variants in the BRCA1 and BRCA2 (BRCA) genes. However, advances in DNA sequencing technologies have made simultaneous testing for multiple genes possible. We examined correlates of interest in multigene panel testing and risk communication preferences in an ethnically diverse sample of women who tested negative for BRCA mutations previously but remain at high risk based on their family history (referred to as "BRCA-uninformative") and their at-risk female family members. Two-hundred and thirteen women with a previous breast cancer diagnosis and a BRCA-uninformative test result and their first-degree relatives completed a survey on interest in multigene panel testing, communication preferences, and sociodemographic, psychological, and clinical factors. Stepwise logistic regression was used to identify factors associated with testing interest. Chi-square analyses were used to test differences in risk communication preferences. Interest in multigene panel testing was high (84%) and did not considerably differ by cancer status or ethnicity. In multivariable analysis, factors significantly associated with interest in genetic testing were having had a mammogram in the past 2 years (odds ratio (OR) = 4.04, 95% confidence interval (CI) 1.80-9.02) and high cancer worry (OR = 3.77, 95% CI 1.34-10.60). Overall, the most commonly preferred genetic communication modes were genetic counselors, oncologists, and print materials. However, non-Hispanic women were more likely than Hispanic women to prefer web-based risk communication (p < 0.001). Hispanic and non-Hispanic women from BRCA-uninformative families have a high level of interest in gene panel testing. Cancer-related emotions and communication preferences should be considered in developing targeted genetic risk communication strategies.
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Affiliation(s)
- Belinda Vicuña
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Robert Wood Johnson Foundation, Center for Health Policy, University of New Mexico, Albuquerque, NM, USA
| | - Harold D Delaney
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kristina G Flores
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Lori Ballinger
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Melanie Royce
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Zoneddy Dayao
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Anita Y Kinney
- Cancer Research Facility, University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC 07 4025, Albuquerque, NM, 87125, USA.
- Robert Wood Johnson Foundation, Center for Health Policy, University of New Mexico, Albuquerque, NM, USA.
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
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Greenbaum A, Wiggins C, Meisner AL, Rojo M, Kinney AY, Rajput A. KRAS biomarker testing disparities in colorectal cancer patients in New Mexico. Heliyon 2017; 3:e00448. [PMID: 29202108 PMCID: PMC5701808 DOI: 10.1016/j.heliyon.2017.e00448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/14/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023] Open
Abstract
Introduction American Society of Clinical Oncology (ASCO) guidelines recommend that all patients with metastatic colorectal cancer (mCRC) receive KRAS testing to guide anti-EGFR monoclonal antibody treatment. The aim of this study was to assess for disparities in KRAS testing and mutational status. Methods The New Mexico Tumor Registry (NMTR), a population-based cancer registry participating in the National Cancer Institute's Surveillance, Epidemiology and End Results program, was queried to identify all incident cases of CRC diagnosed among New Mexico residents from 2010 to 2013. Results Six hundred thirty-seven patients were diagnosed with mCRC from 2010-2013. As expected, KRAS testing in Stage 4 patients presented the highest frequency (38.4%), though testing in stage 3 (8.5%), stage 2 (3.4%) and stage 1 (1.2%) was also observed. In those with metastatic disease, younger patients (≤ 64 years) were more likely to have had testing than patients 65 years and older (p < 0.0001). Patients residing in urban areas received KRAS testing more often than patients living in rural areas (p = 0.019). No significant racial/ethnic disparities were observed (p = 0.66). No significant differences were seen by year of testing. Conclusion Age and geographic disparities exist in the rates of KRAS testing, while sex, race/ethnicity and the year tested were not significantly associated with testing. Further study is required to assess the reasons for these disparities and continued suboptimal adherence to current ASCO KRAS testing guidelines.
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Affiliation(s)
- Alissa Greenbaum
- Department of Surgery, University of New Mexico, Albuquerque, NM, United States
| | - Charles Wiggins
- New Mexico Tumor Registry, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Angela Lw Meisner
- New Mexico Tumor Registry, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Manuel Rojo
- University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Anita Y Kinney
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States.,University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Ashwani Rajput
- Department of Surgery, University of New Mexico, Albuquerque, NM, United States
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Steffen LE, Du R, Gammon A, Mandelblatt JS, Kohlmann WK, Lee JH, Buys SS, Stroup AM, Campo RA, Flores KG, Vicuña B, Schwartz MD, Kinney AY. Genetic Testing in a Population-Based Sample of Breast and Ovarian Cancer Survivors from the REACH Randomized Trial: Cost Barriers and Moderators of Counseling Mode. Cancer Epidemiol Biomarkers Prev 2017; 26:1772-1780. [PMID: 28971986 DOI: 10.1158/1055-9965.epi-17-0389] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/12/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background: This study evaluates predictors of BRCA1/2 testing among breast and ovarian cancer survivors who received genetic counseling as part of a randomized trial and evaluates moderators of counseling mode on testing uptake.Methods: Predictors of BRCA1/2 testing within one year postcounseling were evaluated using multivariable logistic regression in a population-based sample of breast and ovarian cancer survivors at increased hereditary risk randomly assigned to in-person counseling (IPC; n = 379) versus telephone counseling (TC; n = 402). Variables that moderated the association between counseling mode and testing were identified by subgroup analysis.Results: Testing uptake was associated with higher perceived comparative mutation risk [OR = 1.32; 95% confidence interval (CI), 1.11-1.57] in the adjusted analysis. Those without cost barriers had higher testing uptake (OR = 18.73; 95% CI, 7.09-49.46). Psychologic distress and perceived comparative mutation risk moderated the effect of counseling and testing. Uptake between IPC versus TC did not differ at low levels of distress and risk, but differed at high distress (26.3% TC vs. 44.3% IPC) and high perceived comparative risk (33.9% TC vs. 50.5% IPC).Conclusions: Cost concerns are a strong determinant of testing. Differences in testing uptake by counseling mode may depend on precounseling distress and risk perceptions.Impact: Cost concerns may contribute to low testing in population-based samples of at-risk cancer survivors. Precounseling psychosocial characteristics should be considered when offering in-person versus telephone counseling. Cancer Epidemiol Biomarkers Prev; 26(12); 1772-80. ©2017 AACR.
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Affiliation(s)
- Laurie E Steffen
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ruofei Du
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Amanda Gammon
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Wendy K Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ji-Hyun Lee
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Saundra S Buys
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.,Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Rebecca A Campo
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Kristina G Flores
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Belinda Vicuña
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Marc D Schwartz
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. .,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
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Interrante MK, Segal H, Peshkin BN, Valdimarsdottir HB, Nusbaum R, Similuk M, DeMarco T, Hooker G, Graves K, Isaacs C, Wood M, McKinnon W, Garber J, McCormick S, Heinzmann J, Kinney AY, Schwartz MD. Randomized Noninferiority Trial of Telephone vs In-Person Genetic Counseling for Hereditary Breast and Ovarian Cancer: A 12-Month Follow-Up. JNCI Cancer Spectr 2017; 1:pkx002. [PMID: 31304457 PMCID: PMC6611491 DOI: 10.1093/jncics/pkx002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/08/2017] [Accepted: 07/06/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Telephone delivery of genetic counseling is an alternative to in-person genetic counseling because it may extend the reach of genetic counseling. Previous reports have established the noninferiority of telephone counseling on short-term psychosocial and decision-making outcomes. Here we examine the long-term impact of telephone counseling (TC) vs in-person counseling (usual care [UC]). METHODS We recruited high-risk women for a noninferiority trial comparing TC with UC. Of 1057 potentially eligible women, 669 were randomly assigned to TC (n = 335) or UC (n = 334), and 512 completed the 12-month follow-up. Primary outcomes were patient-reported satisfaction with genetic testing decision, distress, and quality of life. Secondary outcomes were uptake of cancer risk management strategies. RESULTS TC was noninferior to UC on all primary outcomes. Satisfaction with decision (d = 0.13, lower bound of 97.5% confidence interval [CI] = -0.34) did not cross its one-point noninferiority limit, cancer-specific distress (d = -2.10, upper bound of 97.5% CI = -0.07) did not cross its four-point noninferiority limit, and genetic testing distress (d = -0.27, upper bound of 97.5% CI = 1.46), physical function (d = 0.44, lower bound of 97.5% CI = -0.91) and mental function (d = -0.04, lower bound of 97.5% CI = -1.44) did not cross their 2.5-point noninferiority limit. Bivariate analyses showed no differences in risk-reducing mastectomy or oophorectomy across groups; however, when combined, TC had significantly more risk-reducing surgeries than UC (17.8% vs 10.5%; χ2 = 4.43, P = .04). CONCLUSIONS Findings support telephone delivery of genetic counseling to extend the accessibility of this service without long-term adverse outcomes.
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Affiliation(s)
- Mary K. Interrante
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Hannah Segal
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Beth N. Peshkin
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Heiddis B. Valdimarsdottir
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Rachel Nusbaum
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Morgan Similuk
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Tiffani DeMarco
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Gillian Hooker
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Kristi Graves
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Claudine Isaacs
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Marie Wood
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Wendy McKinnon
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Judy Garber
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Shelley McCormick
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Jessica Heinzmann
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Anita Y. Kinney
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
| | - Marc D. Schwartz
- Affiliations of authors: Georgetown Lombardi Comprehensive Cancer Center (MKI, HS, BNP, RN, MS, TD, GH, KG, CI, MDS) and Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research (MKI, HS, BNP, KG, CI, MDS), Georgetown University, Washington, DC; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (HBV, JH); Department of Psychology, Reykjavik University, Reykjavik, Iceland (HBV); School of Medicine, University of Maryland, Baltimore, MD (RN); National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (MS); Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA (TD); NextGxDx, Inc, Franklin, TN (GH); Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT (MW, WM); Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute-Harvard Medical School, Boston, MA (JG, SM); Center for Cancer Risk Assessment, Massachusetts General Hospital Cancer Center, Boston, MA (SM); Carol G. Simon Cancer Center, Atlantic Health Services, Summit, NJ (JH); University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT (AYK); Cancer Control and Population Sciences, University of New Mexico Cancer Center, Albuquerque, NM (AYK)
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Affiliation(s)
- Anita Y Kinney
- Anita Y. Kinney, University of New Mexico Comprehensive Cancer Center and University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Barbara H. Brumbach, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; and Marc D. Schwartz, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Wendy Kohlmann
- Anita Y. Kinney, University of New Mexico Comprehensive Cancer Center and University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Barbara H. Brumbach, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; and Marc D. Schwartz, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Barbara H Brumbach
- Anita Y. Kinney, University of New Mexico Comprehensive Cancer Center and University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Barbara H. Brumbach, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; and Marc D. Schwartz, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Marc D Schwartz
- Anita Y. Kinney, University of New Mexico Comprehensive Cancer Center and University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Barbara H. Brumbach, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM; and Marc D. Schwartz, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
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Rutledge TL, Kano M, Guest D, Sussman A, Kinney AY. Optimizing endometrial cancer follow-up and survivorship care for rural and other underserved women: Patient and provider perspectives. Gynecol Oncol 2017; 145:334-339. [PMID: 28325583 DOI: 10.1016/j.ygyno.2017.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/23/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study describes patient and provider attitudes on transitioning cancer surveillance visits and treatment of comorbid conditions to the primary care setting in a rural patient population as a strategy for minimizing financial and travel related barriers for patients while simultaneously enhancing quality and availability of health care options. METHODS Focus group discussions and telephone interviews were conducted with endometrial cancer (EC) survivors and primary care providers (PCPs) to provide insights into post-treatment follow-up practices and the acceptability of transitioning follow-up to primary care setting utilizing a cancer survivorship care plan model. RESULTS EC survivors expressed high levels of satisfaction with their oncology care and suggested that transitioning to PCPs for follow-up care would be convenient yet challenging. Challenges cited include: 1) patient perceptions of deficits in PCP's understandings of cancer surveillance; 2) inability to identify a personal PCP; and 3) lack of communication between oncologists and PCPs. PCP participants similarly identified the need for extensive EC training and effective communication strategies with oncologists as necessary factors for accepting responsibility for EC follow-up care. Both groups offered strategies to create a more team based approach to EC survivorship care. CONCLUSIONS Increasing the role of the PCP in the ongoing care of EC survivors was generally considered acceptable by both patients and providers in both rural and urban women. Successful coordination of care between cancer survivors, oncologists and PCPs will be a critical step in improving the cancer care delivery of our rural patient and provider population.
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Affiliation(s)
- Teresa L Rutledge
- University of New Mexico, University of New Mexico Comprehensive Cancer Center, Department of Obstetrics and Gynecology, United States.
| | - Miria Kano
- University of New Mexico, University of New Mexico Comprehensive Cancer Center, Cancer Research and Treatment Center Population Science Academic Unit, United States
| | - Dolores Guest
- University of New Mexico, University of New Mexico Comprehensive Cancer Center, Cancer Research and Treatment Center Population Science Academic Unit, United States
| | - Andrew Sussman
- University of New Mexico, Department of Family and Community Medicine, United States
| | - Anita Y Kinney
- University of New Mexico, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, United States
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Ginossar T, Shah SFA, West AJ, Bentley JM, Caburnay CA, Kreuter MW, Kinney AY. Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis. JMIR Mhealth Uhealth 2017; 5:e20. [PMID: 28288954 PMCID: PMC5368351 DOI: 10.2196/mhealth.7073] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/13/2017] [Accepted: 01/29/2017] [Indexed: 12/17/2022] Open
Abstract
Background Breast cancer is one of the leading contributors to preventable illness and death among women. Although mobile phone apps provide unprecedented opportunity to engage women along the cancer continuum, little is known about the availability, content, and usability of breast cancer mobile phone apps. Objective This study analyzed the content and adherence to literate design standards of all breast cancer-related apps available on the App Store and Google Play, as well as the relationship between their content, user ratings, and price. Methods Following identification and downloading of all available breast cancer mobile phone apps in October 2015, 101 apps were confirmed as focusing on breast cancer. Based on prior research, we adapted and applied a content analysis scheme that was specific to breast cancer apps, including their main purpose, relevance to the cancer care continuum, and adherence to usability standards outlined by the Institute of Medicine (IOM). Results The most common aim of apps was educational (73/101, 72.3%), followed by behavior change (24/101, 23.9%), fundraising (20/101, 19.8%), and advocacy (14/101, 13.9%). On the cancer continuum, primary prevention (strategies to prevent cancer cells from occurring) was mentioned in almost one-third of the apps (30/101, 29.7%). Less than half of the apps (46/101, 45.5%) presented information about mammography and/or breast clinical exam, and 53 apps (52.5%) discussed breast self-exam (which is no longer recommended). Symptoms of cancer prediagnosis, such as a lump, were discussed in almost half of the apps (48/101, 47.5%) and a similar number of apps included information about genetic risk for breast cancer (47/101, 46.5%). Information about breast cancer diagnosis was included in 42 apps (41.58%) and 43 (42.6%) apps discussed treatment options. Survivorship issues were addressed in 17 (16.8%) apps. Only one (1.0%) app discussed hospice. Adherence to usability recommendations was low. The median composite score was 3 (mean 2.60, SD 1.20) of the six recommended usability items. With eight plain language items, the median of the composite health literacy score was 5 (mean 5.06, SD 2.00). Most apps did not use easy-to-understand words (44/101, 43.6%) and few (24/101, 23.8%) defined key terms. Conclusions Current breast cancer apps provide important information about breast cancer, but the most common topic covered is breast self-examination, a non-evidence-based screening strategy. Apps that focus on evidence-based strategies on the cancer continuum are needed, with a notable pressing need for apps that would address survivorship and end of life. Finally, developers of breast cancer apps should adhere to IOM standards to meet the needs of diverse populations and reduce current disparities.
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Affiliation(s)
- Tamar Ginossar
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, United States
| | - Sayyed Fawad Ali Shah
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, United States
| | - Andrew J West
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, United States
| | - Joshua M Bentley
- Department of Strategic Communication, Texas Christian University, Fort Worth, TX, United States
| | - Charlene A Caburnay
- Health Communication Research Laboratory, Brown School of Social Work, Washington University in Saint Louis, Saint Louis, MO, United States
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Brown School of Social Work, Washington University in Saint Louis, Saint Louis, MO, United States
| | - Anita Y Kinney
- Department of Internal Medicine, Health Science Center, University of New Mexico, Albuquerque, NM, United States
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Pinto N, Sheng X, Keenan HT, Byrne JLB, Stanton B, Kinney AY. Sonographer-Identified Barriers and Facilitators to Prenatal Screening for Congenital Heart Disease. Journal of Diagnostic Medical Sonography 2017. [DOI: 10.1177/8756479316677019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Fetal ultrasound screening for congenital heart disease has high detection rates in efficacy studies but not in practice. We investigated sonographers’ perspectives on barriers to screening and their association with intermediate measures of cardiac imaging. Methods: Barriers to fetal heart screening were identified in focus groups with obstetric sonographers. A web-based survey measured reported barriers and sonographers’ ability to interpret fetal heart screening images. Generalized linear random effect models assessed associations between barriers and image interpretation. Results: Four themes were identified: intrinsic barriers (self-efficacy), external barriers (time), informational needs, and provider and patient expectations. Among 224 sonographers surveyed, an average of 77.6% of fetal heart images were interpreted correctly. Perceptions about self-efficacy ( P = .03) and ease of performing imaging ( P = .01) were associated with accuracy of image interpretation. Conclusions: Several sonographer-identified barriers associated with image interpretation may be novel targets for improving prenatal detection of congenital heart disease.
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Affiliation(s)
- Nelangi Pinto
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Xiaoming Sheng
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Heather T. Keenan
- Pediatric Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Janice L. B. Byrne
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Belva Stanton
- Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Anita Y. Kinney
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
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Abstract
INTRODUCTION DNA sequencing advances through next-generation sequencing (NGS) and several practice changing events, have led to shifting paradigms for inherited cancer predisposition testing. These changes necessitated a means by which to maximize health benefits without unnecessarily inflating healthcare costs and exacerbating health disparities. Areas covered: NGS-based tests encompass multi-gene panel tests, whole exome sequencing, and whole genome sequencing, all of which test for multiple genes simultaneously, compared to prior sequencing practices through which testing was performed sequentially for one or two genes. Taking an ecological approach, this article synthesizes the current literature to consider the broad impact of these advances from the individual patient-, interpersonal-, organizational-, community- and policy-levels. Furthermore, the authors describe how multi-level factors that impact genetic testing and follow-up care reveal great potential to widen existing health disparities if these issues are not addressed. Expert commentary: As we consider ways to maximize patient benefit from testing in a cost effective manner, it is important to consider perspectives from multiple levels. This information is needed to guide the development of interventions such that the promise of genomic testing may be realized by all populations, regardless of race, ethnicity and ability to pay.
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Affiliation(s)
- Deborah Cragun
- University of South Florida, Department of Global Health, College of Public Health
| | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center
- Department of Internal Medicine, University of New Mexico
| | - Tuya Pal
- Department of Cancer Epidemiology, Population Sciences, Moffitt Cancer Center
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Zamora ER, Kaul S, Kirchhoff AC, Gwilliam V, Jimenez OA, Morreall DK, Montenegro RE, Kinney AY, Fluchel MN. The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer. Pediatr Blood Cancer 2016; 63:2173-2180. [PMID: 27442596 DOI: 10.1002/pbc.26150] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 01/27/2016] [Revised: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND An increasing proportion of pediatric cancer patients in the United States are Latino and many have Spanish-speaking immigrant parents with limited English proficiency (LEP). Little is known about how language or undocumented immigration status impacts their care experience. PROCEDURE A cross-sectional survey was administered to English (N = 310) and Spanish-speaking LEP (N = 56) caregivers of pediatric cancer patients. To assess differences in healthcare experiences between the language groups, t-tests and chi-square statistics were used. Multivariable logistic regression evaluated associations between primary language and knowledge of clinical trial status. RESULTS Spanish-speaking caregivers were more likely to report higher rates of quitting or changing jobs as a direct result of their child's cancer, and their children were more likely to experience a delay in education. Although Spanish-speaking caregivers reported higher satisfaction with care, 32% reported feeling that their child would have received better care if English was their primary language. Spanish-speaking caregivers were more likely to incorrectly identify whether their child was on a clinical trial compared with English-speaking caregivers. The majority of Spanish-speaking caregivers reported at least one undocumented caregiver in the household and 11% of them avoided or delayed medical care for their child due to concerns over their undocumented immigration status. CONCLUSIONS Language barriers and undocumented immigration status may negatively impact the quality of informed decision-making and the care experience for Spanish-speaking LEP caregivers of pediatric cancer patients. These families may benefit from culturally appropriate Spanish language resources to improve communication and open a dialogue regarding undocumented immigration status.
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Affiliation(s)
| | - Sapna Kaul
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | - Deborah K Morreall
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Mark N Fluchel
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
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Abstract
Latinas have the highest incidence of cervical cancer, yet Latino parents/guardians' knowledge about and willingness to have their children receive the human papillomavirus (HPV) vaccine is unknown. Latino parents/guardians (N = 67) of children aged 11-17 were recruited from two community organizations to complete a survey, including HPV vaccine knowledge, child's uptake, demographic characteristics, and acculturation. Descriptive statistics and correlates of parents' HPV knowledge and uptake were calculated using Chi square tests and multivariable logistic regression. Receipt of at least one dose of the HPV vaccine was moderate for daughters (49.1%) and low for sons (23.4%). Parents/guardians reported limited knowledge as the main barrier to vaccine receipt. Among parents/guardians with vaccinated daughters, 92.6% did not know the vaccine requires three doses. Adjusting for income, low-acculturated parents were more likely than high-acculturated parents to report inadequate information (OR 8.59, 95% CI 2.11-34.92). Interventions addressing low knowledge and children's uptake of the HPV vaccine are needed among Latino parents/guardians.
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Affiliation(s)
- Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Rm 4144, Salt Lake City, UT, 84112, USA,
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Horick NK, Manful A, Lowery J, Domchek S, Moorman P, Griffin C, Visvanathan K, Isaacs C, Kinney AY, Finkelstein DM. Physical and psychological health in rare cancer survivors. J Cancer Surviv 2016; 11:158-165. [PMID: 27761785 DOI: 10.1007/s11764-016-0573-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 06/16/2016] [Accepted: 09/20/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Registries provide a unique tool for tracking quality of life in rare cancer survivors, whose survivorship experience is less known than for common cancers. This paper reports on these outcomes in 321 patients enrolled in the Rare Cancer Genetics Registry diagnosed with rare gastrointestinal, genitourinary, gynecologic, sarcoma, head/neck, or hematologic cancers. METHODS Four outcomes were assessed, reflecting registrants' self-reported physical and mental health, psychological distress, and loneliness. Combining all patients into a single analysis, regression was used to evaluate the association between outcomes and socio-demographic and clinical factors. RESULTS Median time since diagnosis was 3 years (range 0-9); 69 % were no longer in treatment. Poorer physical health was reported in registrants who were older at diagnosis, unmarried, and still in treatment. Poorer mental status was associated with younger diagnosis age and unmarried status. Psychological distress varied by cancer type and was higher among currently treated and unmarried registrants. Greater loneliness was reported in registrants with gynecological cancers, and those who were less educated or unmarried. The physical and mental health profile of rare cancer survivors is similar to what is reported for common cancers. CONCLUSIONS Unmarried participants reported poorer outcomes on all measures of quality of life. Furthermore, physical and mental health were not significantly different by cancer type after adjustment for diagnosis age, whether currently in treatment and marital status. Thus, the combined analysis performed here is a useful way to analyze outcomes in less common diseases. Our findings could be valuable in guiding evaluation and intervention for issues impacting quality of life. IMPLICATIONS FOR CANCER SURVIVORS Rare cancer survivors, particularly those without spousal support, should be monitored for challenges to the physical as well as psychological aspects of quality of life.
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Affiliation(s)
- Nora K Horick
- Massachusetts General Hospital Biostatistics Center, 50 Staniford St. Suite 560, Boston, MA, 02114, USA
| | - Adoma Manful
- Massachusetts General Hospital Biostatistics Center, 50 Staniford St. Suite 560, Boston, MA, 02114, USA
| | - Jan Lowery
- School of Public Health Department of Epidemiology, University of Colorado Denver, Denver, CO, USA
| | - Susan Domchek
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Constance Griffin
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Anita Y Kinney
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Dianne M Finkelstein
- Massachusetts General Hospital Biostatistics Center, 50 Staniford St. Suite 560, Boston, MA, 02114, USA. .,Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA.
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Kinney AY, Steffen LE, Brumbach BH, Kohlmann W, Du R, Lee JH, Gammon A, Butler K, Buys SS, Stroup AM, Campo RA, Flores KG, Mandelblatt JS, Schwartz MD. Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up. J Clin Oncol 2016; 34:2914-24. [PMID: 27325848 PMCID: PMC5012661 DOI: 10.1200/jco.2015.65.9557] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [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] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The ongoing integration of cancer genomic testing into routine clinical care has led to increased demand for cancer genetic services. To meet this demand, there is an urgent need to enhance the accessibility and reach of such services, while ensuring comparable care delivery outcomes. This randomized trial compared 1-year outcomes for telephone genetic counseling with in-person counseling among women at risk of hereditary breast and/or ovarian cancer living in geographically diverse areas. PATIENTS AND METHODS Using population-based sampling, women at increased risk of hereditary breast and/or ovarian cancer were randomly assigned to in-person (n = 495) or telephone genetic counseling (n = 493). One-sided 97.5% CIs were used to estimate the noninferiority effects of telephone counseling on 1-year psychosocial, decision-making, and quality-of-life outcomes. Differences in test-uptake proportions for determining equivalency of a 10% prespecified margin were evaluated by 95% CIs. RESULTS At the 1-year follow-up, telephone counseling was noninferior to in-person counseling for all psychosocial and informed decision-making outcomes: anxiety (difference [d], 0.08; upper bound 97.5% CI, 0.45), cancer-specific distress (d, 0.66; upper bound 97.5% CI, 2.28), perceived personal control (d, -0.01; lower bound 97.5% CI, -0.06), and decisional conflict (d, -0.12; upper bound 97.5% CI, 2.03). Test uptake was lower for telephone counseling (27.9%) than in-person counseling (37.3%), with the difference of 9.4% (95% CI, 2.2% to 16.8%). Uptake was appreciably higher for rural compared with urban dwellers in both counseling arms. CONCLUSION Although telephone counseling led to lower testing uptake, our findings suggest that telephone counseling can be effectively used to increase reach and access without long-term adverse psychosocial consequences. Further work is needed to determine long-term adherence to risk management guidelines and effective strategies to boost utilization of primary and secondary preventive strategies.
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Affiliation(s)
- Anita Y Kinney
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC.
| | - Laurie E Steffen
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Barbara H Brumbach
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Wendy Kohlmann
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Ruofei Du
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Ji-Hyun Lee
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Amanda Gammon
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Karin Butler
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Saundra S Buys
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Antoinette M Stroup
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Rebecca A Campo
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Kristina G Flores
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Jeanne S Mandelblatt
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Marc D Schwartz
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
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