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Wagner RW, Natori A, Prinsloo S, Otto AK, Saez-Clarke E, Ochoa JM, Tworoger SS, Ulrich CM, Hathaway CA, Ahmed S, McQuade JL, Peoples AR, Antoni MH, Penedo FJ, Cohen L. The role of area deprivation index in health care disruptions among cancer survivors during the SARS-CoV-2 pandemic. Public Health 2024; 232:52-60. [PMID: 38735226 DOI: 10.1016/j.puhe.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/20/2024] [Accepted: 04/05/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To examine the associations between demographic/medical and geographic factors with follow-up medical care and health-related quality of life (HRQoL) among cancer survivors during the SARS-CoV-2 pandemic. STUDY DESIGN Cross-sectional survey. METHODS An online survey was sent to cancer survivors between May 2020 and January 2021, exploring their experience with SARS-CoV-2, follow-up care, and HRQoL. PolicyMap was used to geocode home addresses. Both geographic and demographic/medical factors were examined for their associations with SARS-CoV-2 experience, follow-up care, and HRQoL (FACT-G7). RESULTS Geographic data were available for 9651 participants. Patients living in the highest area deprivation index (ADI) neighborhoods (most deprived) had higher odds of avoiding in-person general (odds ratio [OR] = 7.20; 95% confidence interval [CI] = 2.79-18.60), cancer (OR = 8.47; 95% CI = 3.73-19.30), and emergency (OR = 14.2; 95% CI = 5.57-36.30) medical care, as well as lower odds of using telemedicine (OR = 0.61; 95% CI = 0.52-0.73) compared to the lowest ADI group. Race/ethnicity was not associated with follow-up care after controlling for ADI. The effect of ADI on HRQoL was generally in the expected direction, with higher ADI being associated with worse HRQoL. CONCLUSIONS ADI influenced follow-up medical care more than age, race/ethnicity, or health insurance type. Healthcare providers and institutions should focus on decreasing barriers to in-person and telemedicine health care that disproportionally impact those living in more deprived communities, which are exacerbated by health care disruptions like those caused by the SARS-CoV-2 pandemic.
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Affiliation(s)
- R W Wagner
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Natori
- Division of Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - S Prinsloo
- Department of Palliative, Rehabilitation and Integrative Medicine, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A K Otto
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - E Saez-Clarke
- Department of Psychology, College of Arts and Sciences, University of Miami, FL, USA
| | - J M Ochoa
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S S Tworoger
- Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - C M Ulrich
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - C A Hathaway
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - S Ahmed
- Department of Lymphoma and Myeloma, Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J L McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A R Peoples
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - M H Antoni
- Department of Psychology, College of Arts and Sciences, University of Miami, FL, USA; Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - F J Penedo
- Department of Psychology, College of Arts and Sciences, University of Miami, FL, USA; Department of Medicine & Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - L Cohen
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ramirez AG, Holden AE, Gallion K, SanMiguel SA, Munoz E, Penedo FJ, Perez-Stable EJ, Talavera GG, Carrillo JE, Fernandez ME. Abstract PD08-05: Spanning the Continuum to assess, serve and navigate Latinas with breast cancer: A Tale of Six Projects. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd08-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Breast cancer is the most commonly diagnosed cancer among Latinas: 14,200 diagnosed in 2009. Groundbreaking work has shown that patient navigation may assist minority patients to negotiate the Cancer Care Continuum. Here we report the efforts of Redes En Acción: The National Latino Cancer Research Network at the Institute for Health Promotion Research in San Antonio, Texas in applying these findings to Latinas.
Methods We conducted six studies to assess and address the needs and self-reported barriers to care of Latina breast cancer patients, leading to the development and controlled trial of a theory-driven, culturally appropriate patient navigation model and program. We currently are evaluating health-related quality of life and barriers to genetic testing in Latina breast cancer survivors.
Results Latinas with breast cancer face significant obstacles across the cancer care continuum, originating from multiple domains, including traditional values, timely access to care and cultural orientation. These have a direct influence on interaction with the system or indirectly via influences on existing barriers including socioeconomic marginalization and affective response to the stress of any of these.
Conclusion Although not considered as such, the Cancer Care Continuum implicitly demands consideration of the cultural underpinnings of behavior that govern interaction with it. Further research is required to understand these underpinnings. Simultaneously, culturally-sensitive services must be incorporated into the medical care system in order to ensure its successful function.
Acknowledgement This research was enabled by grants from the San Antonio Cancer Institute/Cancer Therapy and Research Center, San Antonio, Texas (P30-CA054174), Susan G. Komen for the Cure (POP 2000 704), and the National Cancer Institute via Redes En Acción (U01-CA86117 and U54 CA153511-01).
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD08-05.
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Affiliation(s)
- AG Ramirez
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - AE Holden
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - K Gallion
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - SA SanMiguel
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - E Munoz
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - FJ Penedo
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - EJ Perez-Stable
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - GG Talavera
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - JE Carrillo
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - ME Fernandez
- University of Texas Health Science Center at San Antonio, TX; Redes en Accion: The National Latino Cancer Research Network, The University of Texas Health Science Center at San Antonio, San Antonio, TX
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Abstract
This study assessed whether perceived stress as measured by the Perceived Stress Scale (PSS) was associated with a decline in CD4+ cell counts over a six-month period in 59 men and 41 women living with HIV-1. Participants underwent psychological and medical assessment at the study entry (baseline) and again at six months post-baseline. In a hierarchical regression model controlling for sociodemographic (e.g. age, gender, education, income) and disease-related variables (e.g. duration of antiretroviral treatment, antiretroviral treatment and adherence, CD4+ cell count and viral load), perceived stress was associated with the decline in CD4+ cell count over the six-month period. These findings suggest perceived psychosocial stress is associated with CD4+ cell count decline independent of sociodemographic factors and disease status among men and women on antiretroviral medication for HIV/AIDS.
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Affiliation(s)
- E Remor
- Universidad Autónoma de Madrid, Spain.
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Abstract
This-investigation identified personality subgroups based upon cluster analysis of MMPI-2 records of polysubstance abusers. Subgroups were compared on lifetime and current psychiatric symptoms and on attitudes and behaviors linked with HIV infection risk. High psychopathology, mild psychopathology, and subclinical MMPI-2 cluster types were identified which resemble those that have been identified in earlier studies with the original version of the MMPI. The High Psychopathology Subgroup had significantly higher proportions with all lifetime psychiatric problems (ASI), higher levels of all current psychiatric symptoms (SCL-90), and lower levels of confidence in ability to enact safer sexual practices than the Subclinical Cluster Subgroup. Fewer differences in lifetime and concurrent psychiatric symptoms were found in comparisons involving High Pathology and Mild Pathology cluster subgroups and Mild Psychopathology and Subclinical cluster subgroups. Those in the High Psychopathology Subgroup likely need treatment programs that address their more chronic and serious mental health problems and interventions that target their judgment and problem solving limitations that may increase HIV infection risk.
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Affiliation(s)
- R C McMahon
- University of Miami, Counseling Psychology Program, FL 33124, USA
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