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Nwachukwu C, Makhnoon S, Person M, Muthukrishnan M, Kazmi S, Anderson LD, Kaur G, Kapinos KA, Williams EL, Fatunde O, Sadeghi N, Robles F, Basey A, Hulsey T, Pruitt SL, Gerber DE. Transferring care to enhance access to early-phase cancer clinical trials: Protocol to evaluate a novel program. Contemp Clin Trials Commun 2024; 39:101292. [PMID: 38623454 PMCID: PMC11016932 DOI: 10.1016/j.conctc.2024.101292] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/14/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Involving diverse populations in early-phase (phase I and II) cancer clinical trials is critical to informed therapeutic development. However, given the growing costs and complexities of early-phase trials, trial activation and enrollment barriers may be greatest for these studies at healthcare facilities that provide care to the most diverse patient groups, including those in historically underserved communities (e.g., safety-net healthcare systems). To promote diverse and equitable access to early-phase cancer clinical trials, we are implementing a novel program for the transfer of care to enhance access to early-phase cancer clinical trials. We will then perform a mixed-methods study to determine perceptions and impact of the program. Specifically, we will screen, recruit, and enroll diverse patients from an urban, integrated safety-net healthcare system to open and active early-phase clinical trials being conducted in a university-based cancer center. To evaluate this novel program, we will: (1) determine program impact and efficiency; and (2) determine stakeholder experience with and perceptions of the program. To achieve these goals, we will conduct preliminary cost analyses of the program. We will also conduct surveys and interviews with patients and caregivers to elucidate program impact, challenges, and areas for improvement. We hypothesize that broadening access to early-phase cancer trials conducted at experienced centers may improve equity and diversity. In turn, such efforts may enhance the efficiency and generalizability of cancer clinical research.
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Affiliation(s)
- Chika Nwachukwu
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sukh Makhnoon
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Marieshia Person
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Meera Muthukrishnan
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Syed Kazmi
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Larry D. Anderson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gurbakhash Kaur
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kandice A. Kapinos
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- RAND Corporation, Arlington, VA, USA
| | - Erin L. Williams
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Oluwatomilade Fatunde
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Navid Sadeghi
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health, Dallas, TX, USA
| | - Fabian Robles
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health, Dallas, TX, USA
| | - Alice Basey
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Patient Advocate Program, Office of Community Outreach, Engagement, and Equity, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Hulsey
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- Patient Advocate Program, Office of Community Outreach, Engagement, and Equity, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sandi L. Pruitt
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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McDowell A, Rieu-Werden ML, Atlas SJ, Fields CD, Goldstein RH, Gundersen GD, Haas JS, Higashi RT, Pruitt SL, Silver MI, Tiro JA, Kamineni A. Characteristics of Clinicians Caring for Transgender Men and Nonbinary Individuals and Guideline Concordance of Clinicians' Cervical Cancer Screening Counseling for Cisgender Individuals Versus Transgender Men and Nonbinary Individuals with a Cervix. LGBT Health 2024. [PMID: 38648535 DOI: 10.1089/lgbt.2023.0067] [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] [Indexed: 04/25/2024] Open
Abstract
Purpose: We examined characteristics of clinicians caring for transgender men and nonbinary (TMNB) individuals and guideline concordance of clinicians' cervical cancer screening recommendations. Methods: Using a survey of clinicians who performed ≥10 cervical cancer screenings in 2019, we studied characteristics of clinicians who do versus do not report caring for TMNB individuals and guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women. Results: In our sample (N = 492), 49.2% reported caring for TMNB individuals, and 25.4% reported performing cervical cancer screening for TMNB individuals with a cervix. Differences in guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women (45.8% vs. 50% concordant) were not statistically significant. Conclusion: Sizable proportions of clinicians cared for and performed cervical cancer screening for TMNB individuals. Research is needed to better understand clinicians' identified knowledge deficits to develop interventions (e.g., clinician trainings) to improve gender-affirming cervical cancer prevention.
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Affiliation(s)
- Alex McDowell
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan L Rieu-Werden
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven J Atlas
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Robert H Goldstein
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jennifer S Haas
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robin T Higashi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jasmin A Tiro
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Craven CK, Highfield L, Basit M, Bernstam EV, Choi BY, Ferrer RL, Gelfond JA, Pruitt SL, Kannan V, Shireman PK, Spratt H, Morales KJT, Wang CP, Wang Z, Zozus MN, Sankary EC, Schmidt S. Erratum: Toward standardization, harmonization, and integration of social determinants of health data: A Texas Clinical and Translational Science Award institutions collaboration - CORRIGENDUM. J Clin Transl Sci 2024; 8:e62. [PMID: 38655452 PMCID: PMC11036420 DOI: 10.1017/cts.2024.516] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
[This corrects the article DOI: 10.1017/cts.2024.2.].
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Tavakkoli A, Beauchamp A, Prasad T, Zhu H, Singal AG, Elmunzer BJ, Kubiliun NM, Kwon RS, Hughes AE, Pruitt SL. Accessibility to ERCP-performing hospitals among patients with pancreatic cancer living in SEER regions. Cancer Med 2024; 13:e7020. [PMID: 38400670 PMCID: PMC10891451 DOI: 10.1002/cam4.7020] [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: 10/12/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND AIMS The two most common interventions used to treat painless jaundice from pancreatic cancer are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD). Our study aimed to characterize the geographic distribution of ERCP-performing hospitals among patients with pancreatic cancer in the United States and the association between geographic accessibility to ERCP-performing hospitals and biliary interventions patients receive. METHODS This is a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database for pancreatic cancer from 2005 to 2013. Multilevel models were used to examine the association between accessibility to ERCP hospitals within a 30- and 45-min drive from the patient's residential ZIP Code and the receipt of ERCP treatment. A two-step floating catchment area model was used to calculate the measure of accessibility based on the distribution across SEER regions. RESULTS 7464 and 782 patients underwent ERCP and PTBD, respectively, over the study period. There were 808 hospitals in which 8246 patients diagnosed with pancreatic cancer in SEER regions from 2005 to 2013 received a procedure. Patients with high accessibility within both 30- and 45-min drive to an ERCP-performing hospital were more likely to receive an ERCP (30-min adjusted odds ratio [aOR]: 1.53, 95% confidence interval [CI]: 1.17-2.01; 45-min aOR: 1.31, 95% CI: 1.01-1.70). Furthermore, in the adjusted model, Black patients (vs. White) and patients with stage IV disease were less likely to receive ERCP than PTBD. CONCLUSIONS Patients with pancreatic cancer and high accessibility to an ERCP-performing hospital were more likely to receive ERCP. Disparities in the receipt of ERCP persisted for Black patients regardless of their access to ERCP-performing hospitals.
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Affiliation(s)
- Anna Tavakkoli
- Division of Gastroenterology & Liver Diseases, Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Alaina Beauchamp
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Tanushree Prasad
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Hong Zhu
- Department of Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Amit G. Singal
- Division of Gastroenterology & Liver Diseases, Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical CenterDallasTexasUSA
| | - B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Department of MedicineMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Nisa M. Kubiliun
- Division of Gastroenterology & Liver Diseases, Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Richard S. Kwon
- Division of Gastroenterology, Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Amy E. Hughes
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical CenterDallasTexasUSA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Sandi L. Pruitt
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical CenterDallasTexasUSA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical CenterDallasTexasUSA
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Craven CK, Highfield L, Basit M, Bernstam EV, Choi BY, Ferrer RL, Gelfond JA, Pruitt SL, Kannan V, Shireman PK, Spratt H, Morales KJT, Wang CP, Wang Z, Zozus MN, Sankary EC, Schmidt S. Toward standardization, harmonization, and integration of social determinants of health data: A Texas Clinical and Translational Science Award institutions collaboration. J Clin Transl Sci 2024; 8:e17. [PMID: 38384919 PMCID: PMC10880009 DOI: 10.1017/cts.2024.2] [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: 09/07/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction The focus on social determinants of health (SDOH) and their impact on health outcomes is evident in U.S. federal actions by Centers for Medicare & Medicaid Services and Office of National Coordinator for Health Information Technology. The disproportionate impact of COVID-19 on minorities and communities of color heightened awareness of health inequities and the need for more robust SDOH data collection. Four Clinical and Translational Science Award (CTSA) hubs comprising the Texas Regional CTSA Consortium (TRCC) undertook an inventory to understand what contextual-level SDOH datasets are offered centrally and which individual-level SDOH are collected in structured fields in each electronic health record (EHR) system potentially for all patients. Methods Hub teams identified American Community Survey (ACS) datasets available via their enterprise data warehouses for research. Each hub's EHR analyst team identified structured fields available in their EHR for SDOH using a collection instrument based on a 2021 PCORnet survey and conducted an SDOH field completion rate analysis. Results One hub offered ACS datasets centrally. All hubs collected eleven SDOH elements in structured EHR fields. Two collected Homeless and Veteran statuses. Completeness at four hubs was 80%-98%: Ethnicity, Race; < 10%: Education, Financial Strain, Food Insecurity, Housing Security/Stability, Interpersonal Violence, Social Isolation, Stress, Transportation. Conclusion Completeness levels for SDOH data in EHR at TRCC hubs varied and were low for most measures. Multiple system-level discussions may be necessary to increase standardized SDOH EHR-based data collection and harmonization to drive effective value-based care, health disparities research, translational interventions, and evidence-based policy.
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Affiliation(s)
- Catherine K. Craven
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Linda Highfield
- University of Texas Health Science Center at Houston, School of Public Health, San Antonio, TX, USA
| | - Mujeeb Basit
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elmer V. Bernstam
- D. Bradley McWilliams School of Biomedical Informatics and Division of General Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Robert L. Ferrer
- Department of Community and Family Medicine, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Jonathan A. Gelfond
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Sandi L. Pruitt
- University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | | | - Paula K. Shireman
- Department of Surgery, Division of Vascular and Endovascular Surgery, Texas A&M University School of Medicine, Bryan, TX, USA
- Departments of Primary Care & Rural Medicine and Medical Physiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, University of Texas Medical Branch Galveston, Galveston, TX, USA
| | - Kayla J. Torres Morales
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Zhan Wang
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Meredith N. Zozus
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Edward C. Sankary
- University of Texas Health Science Center San Antonio, UT Health Physicians, San Antonio, TX, USA
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
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Stimpson JP, Park S, Pruitt SL. Trusting information on cancer varies by source of information and political viewpoint. Cancer Causes Control 2024; 35:177-184. [PMID: 37651005 DOI: 10.1007/s10552-023-01786-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE This study investigated how trusting information on cancer varies by the source of information and political viewpoint. METHODS This study used cross-sectional survey data from the 2020 Health Information National Trends Survey (HINTS). The study comprised a sample of 2949 adults 18 years and older. The outcome variable was measured by assessing respondents' trust in cancer-related information from various sources, including religious organizations and leaders, government health agencies, charitable organizations, family or friends, and doctors. Political viewpoint was measured as liberal, moderate, and conservative. Multivariate linear probability models were estimated and adjusted for individual-level characteristics. RESULTS Multivariate analysis found that conservatives (73%, 95% CI = 68-78%) were significantly less likely to trust information on cancer from government health agencies compared to liberals (84%, 95% CI = 80-88%). There was no statistically significant difference in trusting government health agencies between liberals and moderates (80%, 95% CI = 76-84%). Both moderates (27%, 95% CI = 21-34%) and conservatives (34%, 95% CI = 29-39%) were more likely to trust information on cancer from religious organizations and leaders compared to liberals (19%, 95% CI = 13-24%). The relationship between political viewpoint and trust of doctors, family or friends, and charitable organizations were not statistically significant. CONCLUSION Compared to liberals, conservatives are more likely to trust information on cancer from religious organizations and leaders and less likely to trust government health agencies when adjusting for other covariates. This finding emphasizes the role of political viewpoint in shaping individuals' perceptions of information sources and cancer-related information.
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Affiliation(s)
- Jim P Stimpson
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Sungchul Park
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Murphy CC, Betts AC, Pruitt SL, Cohn BA, Shay LA, Allicock MA, Wang JS, Lupo PJ. Birth Defects in Offspring of Adolescent and Young Adults with a History of Cancer: A Population-Based Study of 27,000 Women. Cancer Epidemiol Biomarkers Prev 2023; 32:1699-1706. [PMID: 37707371 PMCID: PMC10842971 DOI: 10.1158/1055-9965.epi-23-0743] [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: 06/28/2023] [Revised: 08/03/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND We examined birth defects in offspring of adolescent and young adult (AYA) women with a history of cancer (age 15-39 years at diagnosis). METHODS We identified AYA women diagnosed with cancer between January 1, 1999, and December 31, 2015 using population-based data from the Texas Cancer Registry; data were linked with live birth and fetal death certificates through December 31, 2016 to identify singleton births to AYA women after diagnosis. Birth defects in offspring through age 12 months were ascertained from the Texas Birth Defects Registry. We estimated risk of birth defects in offspring of AYA women and women without cancer (matched 3:1 by maternal race/ethnicity, maternal age, and offspring year of birth) and compared risk using log binomial regression models. RESULTS There were 6,882 singleton births to AYA women after diagnosis. Common cancer types were thyroid (28.9%), lymphoma (12.5%), and breast (10.7%). Risk of any birth defect was higher in offspring of AYA women (6.0%) compared with offspring of women without cancer [n = 20,646; 4.8%; risk ratio (RR) 1.24; 95% confidence interval (CI), 1.11-1.38]. Risk of eye or ear (RR, 1.39; 95% CI, 1.03-1.90), heart and circulatory (RR, 1.32; 95% CI, 1.09-1.60), genitourinary (RR, 1.38; 95% CI, 1.12-1.69), and musculoskeletal (RR, 1.37; 95% CI, 1.13-1.66) defects was also higher. CONCLUSIONS Risk of birth defects was elevated in liveborn and stillborn offspring of AYA women. IMPACT Although birth defects are rare, AYA women making decisions about pregnancy and prenatal care should receive appropriate counseling and surveillance.
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Affiliation(s)
- Caitlin C. Murphy
- Department of Health Promotion & Behavioral Sciences, UTHealth Houston School of Public Health, Houston, TX, USA
| | - Andrea C. Betts
- Department of Health Promotion & Behavioral Sciences, UTHealth Houston School of Public Health, Houston, TX, USA
| | - Sandi L. Pruitt
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Barbara A. Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - L. Aubree Shay
- Department of Health Promotion & Behavioral Sciences, UTHealth Houston School of Public Health, Houston, TX, USA
| | - Marlyn A. Allicock
- Department of Health Promotion & Behavioral Sciences, UTHealth Houston School of Public Health, Houston, TX, USA
| | - Jennifer S. Wang
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Houston, TX, USA
| | - Philip J. Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Guan A, Pruitt SL, Henry KA, Lin K, Meltzer D, Canchola AJ, Rathod AB, Hughes AE, Kroenke CH, Gomez SL, Hiatt RA, Stroup AM, Pinheiro PS, Boscoe FP, Zhu H, Shariff-Marco S. Asian American Enclaves and Healthcare Accessibility: An Ecologic Study Across Five States. Am J Prev Med 2023; 65:1015-1025. [PMID: 37429388 PMCID: PMC10921977 DOI: 10.1016/j.amepre.2023.07.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Access to primary care has been a long-standing priority for improving population health. Asian Americans, who often settle in ethnic enclaves, have been found to underutilize health care. Understanding geographic primary care accessibility within Asian American enclaves can help to ensure the long-term health of this fast-growing population. METHODS U.S. Census data from five states (California, Florida, New Jersey, New York, and Texas) were used to develop and describe census-tract level measures of Asian American enclaves and social and built environment characteristics for years 2000 and 2010. The 2-step floating catchment area method was applied to National Provider Identifier data to develop a tract-level measure of geographic primary care accessibility. Analyses were conducted in 2022-2023, and associations between enclaves (versus nonenclaves) and geographic primary care accessibility were evaluated using multivariable Poisson regression with robust variance estimation, adjusting for potential area-level confounders. RESULTS Of 24,482 census tracts, 26.1% were classified as Asian American enclaves. Asian American enclaves were more likely to be metropolitan and have less poverty, lower crime, and lower proportions of uninsured individuals than nonenclaves. Asian American enclaves had higher primary care accessibility than nonenclaves (adjusted prevalence ratio=1.23, 95% CI=1.17, 1.29). CONCLUSIONS Asian American enclaves in five of the most diverse and populous states in the U.S. had fewer markers of disadvantage and greater geographic primary care accessibility. This study contributes to the growing body of research elucidating the constellation of social and built environment features within Asian American enclaves and provides evidence of health-promoting characteristics of these neighborhoods.
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Affiliation(s)
- Alice Guan
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin A Henry
- Department of Geography and Urban Studies, College of Liberal Arts, Temple University, Philadelphia, Pennsylvania; Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Katherine Lin
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Dan Meltzer
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Alison J Canchola
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Aniruddha B Rathod
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy E Hughes
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Candyce H Kroenke
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Robert A Hiatt
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | | | - Paulo S Pinheiro
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | | | - Hong Zhu
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
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Hollis-Hansen K, Haskins C, Turcios J, Bowen ME, Leonard T, Lee M, Albin J, Wadkins-Chambers B, Thompson C, Hall T, Pruitt SL. A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients. BMC Public Health 2023; 23:2389. [PMID: 38041070 PMCID: PMC10691040 DOI: 10.1186/s12889-023-17355-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving. METHODS Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n = 35) or no-prep meals (n = 35). Participants completed questionnaires at baseline and two-week follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation. RESULTS Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp²=0.16, F(1,64) = 11.78, p < .001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp²=0.36, F(1,64) = 36.38, p < .001) and food security (ηp²=0.36, F(1,64) = 36.38, p < .001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp²=0.09, F(1,64) = 6.28, p = .015). CONCLUSIONS Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes. TRIAL REGISTRATION This trial was registered on 25/10/2022 on ClinicalTrials.gov, identifier: NCT05593510.
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Affiliation(s)
- Kelseanna Hollis-Hansen
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US.
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, US.
| | - Carolyn Haskins
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
| | - Jessica Turcios
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
| | - Michael E Bowen
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
- Internal Medicine, UT Southwestern Medical Center, Dallas, TX, US
| | - Tammy Leonard
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, US
| | - MinJae Lee
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, US
| | - Jaclyn Albin
- Pediatrics and Internal Medicine, UT Southwestern Medical Center, Dallas, TX, US
| | | | | | - Taylor Hall
- Crossroads Community Services, Dallas, TX, US
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, US
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, US
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10
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Hollis-Hansen K, Haskins C, Turcios J, Bowen ME, Leonard T, Lee M, Albin J, Chambers BW, Thompson C, Hall T, Pruitt SL. A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients. Res Sq 2023:rs.3.rs-3029813. [PMID: 37886450 PMCID: PMC10602110 DOI: 10.21203/rs.3.rs-3029813/v1] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving. Methods Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n=35) or no-prep meals (n=35). Participants completed questionnaires at baseline and twoweek follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation. Results Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp2=0.16, F(1,64)=11.78, p<.001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp2=0.36, F(1,64)=36.38, p<.001) and food security (ηp2=0.36, F(1,64)=36.38, p<.001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp2=0.09, F(1,64)=6.28, p=.015). Conclusions Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes. Trial Registration This trial was registered on 25/10/2022 on Clinicaltrials.gov, identifier: NCT05593510.
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Spencer JC, Kim JJ, Tiro JA, Feldman SJ, Kobrin SC, Skinner CS, Wang L, McCarthy AM, Atlas SJ, Pruitt SL, Silver MI, Haas JS. Racial and Ethnic Disparities in Cervical Cancer Screening From Three U.S. Healthcare Settings. Am J Prev Med 2023; 65:667-677. [PMID: 37146839 DOI: 10.1016/j.amepre.2023.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION This study sought to characterize racial and ethnic disparities in cervical cancer screening and follow-up of abnormal findings across 3 U.S. healthcare settings. METHODS Data were from 2016 to 2019 and were analyzed in 2022, reflecting sites within the Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations Research Center, part of the Population-based Research to Optimize the Screening Process consortium, including a safety-net system in the southwestern U.S., a northwestern mixed-model system, and a northeastern integrated healthcare system. Screening uptake was evaluated among average-risk patients (i.e., no previous abnormalities) by race and ethnicity as captured in the electronic health record, using chi-square tests. Among patients with abnormal findings requiring follow-up, the proportion receiving colposcopy or biopsy within 6 months was reported. Multivariable regression was conducted to assess how clinical, socioeconomic, and structural characteristics mediate observed differences. RESULTS Among 188,415 eligible patients, 62.8% received cervical cancer screening during the 3-year study period. Screening use was lower among non-Hispanic Black patients (53.2%) and higher among Hispanic (65.4%,) and Asian/Pacific Islander (66.5%) than among non-Hispanic White patients (63.5%, all p<0.001). Most differences were explained by the distribution of patients across sites and differences in insurance. Hispanic patients remained more likely to screen after controlling for a variety of clinical and sociodemographic factors (risk ratio=1.14, CI=1.12, 1.16). Among those receiving any screening test, Black and Hispanic patients were more likely to receive Pap-only testing (versus receiving co-testing). Follow-up from abnormal results was low for all groups (72.5%) but highest among Hispanic participants (78.8%, p<0.001). CONCLUSIONS In a large cohort receiving care across 3 diverse healthcare settings, cervical cancer screening and follow-up were below 80% coverage targets. Lower screening for Black patients was attenuated by controlling for insurance and site of care, underscoring the role of systemic inequity. In addition, it is crucial to improve follow-up after abnormalities are identified, which was low for all populations.
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Affiliation(s)
- Jennifer C Spencer
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas; Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas.
| | - Jane J Kim
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, Massachussetts
| | - Jasmin A Tiro
- Department Public Health Sciences, The University of Chicago, Chicago, Illinois; University of Chicago Medicine Comprehensive Cancer Center, The University of Chicago, Chicago, Ilinois
| | - Sarah J Feldman
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussetts
| | - Sarah C Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Celette Sugg Skinner
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lei Wang
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve J Atlas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachussetts
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michelle I Silver
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachussetts
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McGuire MF, Chen PM, Smith-Morris C, Albin J, Siler MD, Lopez MA, Pruitt SL, Merrill VC, Bowen ME. Redesigning Recruitment and Engagement Strategies for Virtual Culinary Medicine and Medical Nutrition Interventions in a Randomized Trial of Patients with Uncontrolled Type 2 Diabetes. Nutrients 2023; 15:4124. [PMID: 37836408 PMCID: PMC10574259 DOI: 10.3390/nu15194124] [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: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
In-person culinary medicine (CM) can improve health behaviors, but its translation to virtual platforms and impact on diabetes outcomes are not well described. We designed a pragmatic trial comparing the effectiveness of virtual CM (eCM) to Medical Nutrition Therapy on diabetes outcomes among patients with uncontrolled diabetes within a safety-net healthcare system. All participants were provided cooking equipment and food from a food pantry. Due to low initial eCM participation, recruitment was paused, and eight semi-structured interviews were conducted to solicit feedback on study appeal, operations, and barriers to participation. Rapid thematic analysis was used to modify study operations. We found that participants were interested in the study and motivated by health concerns. While they valued food distribution and cooking equipment, they highlighted transportation barriers and conflicts with the pick-up time/location. Some eCM participants expressed discomfort with the virtual platform or preferred to observe rather than cook along. Study operations were modified by (1) moving supply pick-up to a familiar community clinic and diversifying food pick-up locations; (2) offering an in-person orientation to the program to increase comfort with the virtual platform; (3) emphasizing the credibility and relatability of the eCM instructor and encouraging participation of family members. This redesign led to the recruitment of 79 participants, of whom 75% attended at least one class. In conclusion, participant feedback informed pragmatic changes in study operations that increased engagement in this ongoing trial and may inform future eCM program design.
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Affiliation(s)
- Molly F. McGuire
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
| | - Patricia M. Chen
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | | | - Jaclyn Albin
- University of Texas Southwestern Medical Center, Division of Combined Internal Medicine and Pediatrics, Dallas, TX 75390, USA
| | - Milette D. Siler
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
- Moncrief Cancer Institute, Fort Worth, TX 76104, USA
| | | | - Sandi L. Pruitt
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Vincent C. Merrill
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
| | - Michael E. Bowen
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
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13
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Narasimman M, Pruitt SL, Murphy CC, Singal AG, Tavakkoli A. Ethnic Disparities in Early-Onset Gastric Cancer Persist across Rural-Urban Geographies. Cancer Epidemiol Biomarkers Prev 2023; 32:1169-1173. [PMID: 37352435 DOI: 10.1158/1055-9965.epi-23-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/18/2023] [Accepted: 06/21/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The incidence of noncardia gastric cancer is increasing in adults ages less than 50 years old. Early-onset gastric cancer (EOGC) is characterized by ethnic disparities occurring more in Hispanic persons than non-Hispanic persons. It is unknown whether rural-urban disparities exist in EOGC and if this intersects with ethnic disparities. METHODS We utilized the Surveillance Epidemiology and End Results 17 Census Tract-level Socioeconomic Status and Rurality Database from 2006 to 2018 to calculate incidence rates and incidence rate ratios of EOGC among Hispanic and non-Hispanic persons by census tract rural-urban location, age, gender, persistent poverty, and stage of disease. We used the Tiwari Method to estimate incidence rate ratios with 95% confidence intervals (CI). RESULTS Hispanic persons had higher incidence rates of EOGC compared with non-Hispanic persons in both rural [incident rate ratios (IRR), 2.12; 95% confidence interval (CI), 1.64-2.73] and urban census tracts (IRR, 2.03; 95% CI, 1.91-2.16). Similar findings were seen when comparing Hispanic to non-Hispanic persons in rural and urban census tracts by age, stage of disease, and persistent poverty. CONCLUSIONS Higher incidence rates of EOGC among Hispanic persons persist across rural-urban locations. Further research is needed to understand the etiology of this elevated risk in young Hispanics and interventions that may help to modify their outcome. IMPACT While other cancers have ethnic disparities which may differ by rural-urban location, the ethnic disparity in EOGC among Hispanic and non-Hispanic persons does not differ by rural-urban residence.
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Affiliation(s)
- Manasa Narasimman
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Caitlin C Murphy
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Amit G Singal
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Anna Tavakkoli
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
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Tavakkoli A, Pruitt SL, Murphy CC. Cancer Progress and Priorities: Gastric Cancer-Letter. Cancer Epidemiol Biomarkers Prev 2023; 32:1270. [PMID: 37655426 PMCID: PMC10593426 DOI: 10.1158/1055-9965.epi-23-0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Anna Tavakkoli
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas
| | - Sandi L. Pruitt
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, Texas
- Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas
| | - Caitlin C. Murphy
- University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX
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15
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Murphy CC, Tortolero GA, Gerber DE, Pruitt SL. An Updated Report on the Prevalence of Prior Cancer Among Persons Newly Diagnosed With Cancer in the Surveillance, Epidemiology, and End Results Program. JAMA Oncol 2023; 9:1147-1150. [PMID: 37318821 PMCID: PMC10273127 DOI: 10.1001/jamaoncol.2023.1723] [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: 12/05/2022] [Accepted: 04/05/2023] [Indexed: 06/16/2023]
Abstract
This cohort study uses population-based data from the National Cancer Institute Surveillance, Epidemiology, and End Results program of cancer registries to estimate prevalence of prior cancer among adults diagnosed with an incident cancer in 2019.
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Affiliation(s)
- Caitlin C. Murphy
- University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health
| | - Guillermo A. Tortolero
- University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health
| | - David E. Gerber
- Division of Hematology Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas
| | - Sandi L. Pruitt
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas
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16
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Jain S, Shahan K, Bowen M, Pruitt SL. Dietary intake of individuals receiving Supplemental Nutrition Assistance Program and food pantry assistance in North Texas. Public Health Nutr 2023; 26:1082-1087. [PMID: 35321780 PMCID: PMC10346013 DOI: 10.1017/s136898002200074x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Food pantries and the Supplemental Nutrition Assistance Program (SNAP) are widely available resources for individuals facing food insecurity, yet the dietary quality of individuals using both programmes is not well characterised. We describe the dietary intake of individuals in North Texas who use both food pantries and SNAP to identify nutritional gaps and opportunities to improve food assistance programmes. DESIGN We analysed baseline data from a randomised controlled trial examining food security and dietary intake. At baseline, we administered the validated, 26-item Dietary Screener Questionnaire (DSQ). We calculated descriptive statistics for dietary intake variables and compared with the 2020-2025 Dietary Guidelines for Americans recommended intake values. SETTING Two large food pantries in Dallas County, TX. PARTICIPANTS Eligible participants were English or Spanish speaking adults receiving SNAP benefits who had used the food pantry within the last 4 months. RESULTS We analysed baseline DSQ data from 320 participants (mean age 47 years; 90% female; 45% Black or African American; 37% Hispanic or Latino). Despite receiving SNAP benefits and food pantry assistance, most participants did not meet the minimum recommended intake values for fruits (88.4%), vegetables (97.4%), fibre (90·7%), whole grains (99·7%), dairy products (98·4%) and Ca (83·4%). Furthermore, 73·2% of participants exceeded the maximum recommended intake for added sugar. Still, the gap between median daily intake and recommended daily intake could be partially bridged with food obtained through current food assistance programmes. CONCLUSIONS Multilevel, coordinated approaches within both SNAP and food pantry networks are needed to improve diet quality in individuals receiving food assistance.
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Affiliation(s)
- Seema Jain
- Internal Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, E1, Dallas, TX75390, USA
| | - Kathryn Shahan
- Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Bowen
- Internal Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, E1, Dallas, TX75390, USA
- Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandi L Pruitt
- Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Del Vecchio NJ, Beaber EF, Garcia MP, Wheeler CM, Kamineni A, Chao C, Chubak J, Corley DA, Owens CL, Winer RL, Pruitt SL, Raine-Bennett T, Feldman S, Silverberg M. Provider- and Facility-Level Variation in Precancerous Cervical Biopsy Diagnoses. J Low Genit Tract Dis 2023; 27:113-119. [PMID: 36728078 PMCID: PMC10038855 DOI: 10.1097/lgt.0000000000000721] [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: 02/03/2023]
Abstract
OBJECTIVES Reproducibility of cervical biopsy diagnoses is low and may vary based on where the diagnostic test is performed and by whom. Our objective was to measure multilevel variation in diagnoses across colposcopists, pathologists, and laboratory facilities. METHODS We cross-sectionally examined variation in cervical biopsy diagnoses within the 5 sites of the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR I) consortium within levels defined by colposcopists, pathologists, and laboratory facilities. Patients aged 18 to 65 years with a colposcopy with biopsy performed were included, with diagnoses categorized as normal, cervical intraepithelial neoplasia grade 1 (CIN1), grade 2 (CIN2), and grade 3 (CIN3). Using Markov Chain Monte-Carlo methods, we fit mixed-effects logistic regression models for biopsy diagnoses and presented median odds ratios (MORs), which reflect the variability within each level. Median odds ratios can be interpreted as the average increased odds a patient would have for a given outcome (e.g., CIN2 or CIN3 vs normal or CIN1) when switching to a provider with higher odds of diagnosing that outcome. The MOR is always 1 or greater, and a value of 1 indicates no variation in outcome for that level, with higher values indicating greater variation. RESULTS A total of 130,110 patients were included who received care across 82 laboratory facilities, 2,620 colposcopists, and 489 pathologists. Substantial variation in biopsy diagnoses was found at each level, with the most occurring between laboratory facilities, followed by pathologists and colposcopists. Substantial variation in biopsy diagnoses of CIN2 or CIN3 (vs normal or CIN1) was present between laboratory facilities (MOR: 1.26; 95% credible interval = 1.19-1.36). CONCLUSIONS Improving consistency in cervical biopsy diagnoses is needed to reduce underdiagnosis, overdiagnosis, and unnecessary treatment resulting from variation in cervical biopsy diagnoses.
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Affiliation(s)
| | - Elisabeth F. Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Michael P. Garcia
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Rachel L. Winer
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; and Harold C. Simmons Cancer Center, Dallas, Texas
| | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Michael Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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18
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Ibekwe LN, Fernández-Esquer ME, Pruitt SL, Ranjit N, Fernández ME. Associations between perceived racial discrimination, racial residential segregation, and cancer screening adherence among low-income African Americans: a multilevel, cross-sectional analysis. Ethn Health 2023; 28:313-334. [PMID: 35229698 PMCID: PMC9433466 DOI: 10.1080/13557858.2022.2043246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 04/07/2021] [Accepted: 02/11/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES African Americans suffer disproportionately from cancer compared to their White counterparts. Racism may be an important determinant, but the literature on its association with cancer screening is limited. We examine associations between racism and cancer screening among a sample of African Americans. DESIGN Guided by the Public Health Critical Race Praxis and the Behavioral Model of Health Services Use, we conducted a multilevel, cross-sectional study using cancer risk assessment data collected from 405 callers to the 2-1-1 Texas helpline. We merged these data with contextual data from the U.S. Census Bureau. We assessed perceived racial discrimination using the Experiences of Discrimination Scale and racial residential segregation using the Location Quotient for Racial Residential Segregation. We used multilevel regression models to test hypothesized associations between each indicator of racism and four cancer screening adherence outcomes (Pap test, mammography, colorectal cancer screening [CRCS], and any cancer screening). RESULTS Participants were 18-83 years old (mean = 45 years). Most (81%) were non-adherent to at least one recommended screening. Approximately 42% reported experiencing discrimination and 73% lived in a segregated neighborhood. Discrimination was non-significantly related to lower odds of mammography (aOR = 0.68; 95%CI: 0.38-1.22), CRCS (aOR = 0.79; 95%CI: 0.41-1.52), and any cancer screening adherence (aOR = 0.88; 95%CI: 0.59-1.32). Segregation was related to greater odds of mammography (non-significant; aOR = 1.43; 95%CI: 0.76-2.68) and CRCS (significant; aOR = 2.80; 95%CI: 1.21-6.46) but not associated with any cancer screening. Neither indicator of racism was associated with Pap test screening adherence. CONCLUSIONS Racism has a nuanced association with cancer screening among low-income, medically underserved African Americans. Specifically, discrimination appears to be associated with lower odds of screening, while segregation may be associated with higher odds of screening in certain situations. Future research is needed to better explicate relations between indicators of racism and cancer screening among African Americans.
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Affiliation(s)
- Lynn N Ibekwe
- School of Public Health, Center at Houston, Center for Health Promotion and Prevention Research, The University of Texas Health Science, Houston, TX, USA
- Department of Social and Behavioral Sciences, School of Public Health, Boston, MA, USA
- Massachusetts General Hospital, Kraft Center for Community Health, Boston, MA, USA
| | - Maria Eugenia Fernández-Esquer
- School of Public Health, Center at Houston, Center for Health Promotion and Prevention Research, The University of Texas Health Science, Houston, TX, USA
| | - Sandi L Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nalini Ranjit
- Michael and Susan Dell Center for Healthy Living, School of Public Health- Austin Regional Campus, The University of Texas Health Science Center at Houston, Austin, TX, USA
| | - Maria E Fernández
- School of Public Health, Center at Houston, Center for Health Promotion and Prevention Research, The University of Texas Health Science, Houston, TX, USA
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19
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Betts AC, Shay LA, Lupo PJ, Pruitt SL, Roth ME, Allicock MA, Cohn BA, Murphy CC. Adverse birth outcomes of adolescent and young adult women diagnosed with cancer during pregnancy. J Natl Cancer Inst 2023:7076613. [PMID: 36912709 DOI: 10.1093/jnci/djad044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND We examined adverse birth outcomes among adolescent and young adult women diagnosed with cancer (AYA women, ages 15-39 years) during pregnancy. METHODS We linked data from the Texas Cancer Registry, vital records, and Texas Birth Defects Registry to identify all singleton births to AYA women diagnosed during pregnancy from January 1999 to December 2016. We compared prevalence of adverse live birth outcomes between AYA women and women without cancer (matched 1:4 on age, race and ethnicity, and year). Among AYA women, we used log-binomial regression to identify factors associated with these outcomes. Statistical tests were 2-sided. RESULTS AYA women had 1,271 singleton live births and 20 stillbirths. AYA women (n=1,291) were 33.3% Hispanic and 9.8% non-Hispanic Black and most commonly had breast (22.5%), thyroid (19.8%), and gynecologic (13.3%) cancers. Among live births, AYA women had a higher prevalence of low birth weight offspring (30.1% vs. 9.0%), very preterm (5.7% vs. 1.2%) and preterm birth (25.1% vs. 7.2%), cesarean delivery (44.3% vs. 35.2%), and low Apgar score (2.7% vs. 1.5%), compared to women without cancer (n=5,084) (all p<0.05). Prevalence of any birth defect by age 12 months did not statistically differ (5.2% vs. 4.7%, p=0.48), but live births to AYA women more often had heart and circulatory system defects (2.2% vs. 1.3%, p=0.01). In adjusted models, cancer type and chemotherapy were associated with adverse live birth outcomes. CONCLUSIONS AYA women diagnosed during pregnancy have higher prevalence of adverse birth outcomes and face difficult decisions in balancing treatment risks and benefits.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Science, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Science, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA.,Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Michael E Roth
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marlyn A Allicock
- Department of Health Promotion and Behavioral Science, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA.,Center for Health Promotion and Prevention Research, Houston, TX, USA
| | | | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Science, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA.,Center for Health Promotion and Prevention Research, Houston, TX, USA
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20
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Rathod A, Murphy CC, Rahimi A, Pruitt SL. Revisiting Exclusion of Prior Cancer in Clinical Trials of Male Breast Cancer. J Cancer 2023; 14:737-740. [PMID: 37056393 PMCID: PMC10088891 DOI: 10.7150/jca.80740] [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: 11/11/2022] [Accepted: 02/22/2023] [Indexed: 04/15/2023] Open
Abstract
Background: Eligibility criteria for cancer clinical trials present challenges to enrollment. Many trials exclude patients with a prior cancer. This common practice may be especially detrimental to trials of rare cancers, such as male breast cancer, that struggle to accrue adequate numbers of participants. Objectives: To estimate prevalence of prior cancer among men newly diagnosed with breast cancer and describe characteristics of men with prior cancer compared to those without. Methods: We identified men diagnosed with breast cancer between 2011-2015 using population-based data from National Cancer Institute's Surveillance, Epidemiology, and End Results program of cancer registries. We used sequence number and diagnosis year to identify cancers diagnosed prior to breast cancer (inclusive of prior breast, different, and unknown types of cancer). We compared sociodemographic, tumor, and treatment characteristics of men with and without prior cancer using chi-square tests. Results: Among 2317 men, nearly one quarter (24.3%) had any prior cancer, and the majority (58.7%) of these were of a different cancer type. A higher proportion of men with a prior cancer of a different type were older, had smaller (≤ 2 cm) breast tumors, were diagnosed with stage 0-1 breast cancer, and did not receive surgery compared to men without any prior cancer; there were no statistically significant differences by race and ethnicity, county median income, hormone receptor status, or surgery type. Conclusion: Given prevalence of prior cancer in this rare and understudied population of men diagnosed with breast cancer, including men with prior cancer in clinical trials may improve accrual.
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Affiliation(s)
- Aniruddha Rathod
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas TX
| | - Caitlin C. Murphy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Asal Rahimi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas TX
| | - Sandi L. Pruitt
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas TX
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas TX
- ✉ Corresponding author: Sandi L. Pruitt, Associate Professor, Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, 214.648.3257;
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21
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Pruitt SL, Tavakkoli A, Zhu H, Heitjan DF, Gerber DE, Singal AG, Halm EA, Beg MS, Maddineni B, Kansagra AJ, Murphy CC. Survival of cancer survivors with a new pancreatic cancer diagnosis. Cancer Med 2023; 12:200-212. [PMID: 35674139 PMCID: PMC9844592 DOI: 10.1002/cam4.4903] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Persons newly diagnosed with pancreas cancer and who have survived a previous cancer are often excluded from clinical trials, despite limited evidence about their prognosis. We examined the association between previous cancer and overall survival. METHODS This US population-based cohort study included older adults (aged ≥66 years) diagnosed with pancreas cancer between 2005 and 2015 in the linked Surveillance, Epidemiology, and End Results-Medicare data. We used Cox proportional hazards models to estimate stage-specific effects of previous cancer on overall survival, adjusting for sociodemographic, treatment, and tumor characteristics. RESULTS Of 32,783 patients, 18.7% were previously diagnosed with another cancer. The most common previous cancers included prostate (29.0%), breast (18.9%), or colorectal (9.7%) cancer. More than half of previous cancers (53.9%) were diagnosed 5 or more years prior to pancreas cancer diagnosis or at an in situ or localized stage (47.8%). The proportions of patients surviving 1, 3, and 5 years after pancreas cancer were nearly identical for those with and without previous cancer. Median survival in months was as follows for those with and without previous cancer respectively: 7 versus 8 (Stage 0/I), 10 versus 10 (Stage II), 7 versus 7 (Stage III), and 3 versus 2 (Stage IV). Cox models indicated that patients with previous cancer had very similar or statistically equivalent survival to those with no previous cancer. CONCLUSIONS Given nearly equivalent survival compared to those without previous cancer, cancer survivors newly diagnosed with pancreas cancer should be considered for inclusion in pancreas cancer clinical trials.
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Affiliation(s)
- Sandi L. Pruitt
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
| | - Anna Tavakkoli
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Hong Zhu
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
| | - Daniel F. Heitjan
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Statistical ScienceSouthern Methodist UniversityDallasTexasUSA
| | - David E. Gerber
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Amit G. Singal
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ethan A. Halm
- Rutgers Biological Health Sciences (RBHS)Rutgers UniversityNew BrunswickNew JerseyUSA
- Robert Wood Johnson Medical SchoolDepartment of MedicineNew BrunswickNew JerseyUSA
| | | | - Bhumika Maddineni
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ankit J. Kansagra
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Caitlin C. Murphy
- School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTexasUSA
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22
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Murphy CC, Betts AC, Allicock MA, Shay LA, Preston SM, Cohn BA, Lupo PJ, Pruitt SL. Stillbirth After Adolescent and Young Adult Cancer: A Population-Based Study. J Natl Cancer Inst 2022; 114:1674-1680. [PMID: 36029247 PMCID: PMC9745431 DOI: 10.1093/jnci/djac168] [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: 06/14/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gonadotoxic effects of cancer treatment may increase risk of adverse birth outcomes in adolescent and young adult (AYA, aged 15-39 years) women diagnosed with cancer. We estimated risk of stillbirth (fetal death of gestational age ≥20 weeks or weighing ≥350 grams) in a population-based sample of AYA women. METHODS AYA women diagnosed with cancer between January 1, 1995, and December 31, 2015, were identified using the Texas Cancer Registry and linked to live birth and fetal death certificates through December 31, 2016. Among AYA women, cumulative incidence of stillbirth was estimated by gestational age, and Poisson regression models identified factors associated with stillbirth. Standardized fetal mortality ratios (SMR) compared the observed fetal mortality rate in AYA women with the expected fetal mortality rate in the general population. RESULTS A total of 11 628 live births and 68 stillbirths occurred to 8402 AYA women after diagnosis. Cumulative incidence of stillbirth in AYA women was 0.70% (95% confidence interval [CI] = 0.51% to 0.96%) at 40 weeks of gestation. Risk of stillbirth was higher among Hispanic (risk ratio [RR] = 2.64, 95% CI = 1.29 to 5.41) and non-Hispanic Black (RR = 4.13, 95% CI = 1.68 to 10.16) women compared with non-Hispanic White women; there was no association with receipt of chemotherapy or time since diagnosis. Age- and race and ethnicity-adjusted fetal mortality rate in AYA women was similar to the general population (SMR = 0.99, 95% CI = 0.77 to 1.26). CONCLUSIONS AYA women may be counseled that overall risk of stillbirth is low, and for most, cancer does not appear to confer additional risk.
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Affiliation(s)
- Caitlin C Murphy
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Andrea C Betts
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Dallas Regional Campus, Dallas, TX, USA
| | - Marlyn A Allicock
- Center for Health Promotion and Prevention Research, Houston, TX, USA
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Dallas Regional Campus, Dallas, TX, USA
| | - L Aubree Shay
- Center for Health Promotion and Prevention Research, Houston, TX, USA
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, San Antonio Regional Campus, San Antonio, TX, USA
| | - Sharice M Preston
- Department of Health Promotion & Behavioral Sciences, University of Texas Health School of Public Health, Houston, TX, USA
- Texas Center for Pediatric Population Health, Dallas, TX, USA
| | - Barbara A Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandi L Pruitt
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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23
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Muñiz JP, Woodhouse JP, Hughes AE, Pruitt SL, Rabin KR, Scheurer ME, Lupo PJ, Schraw JM. Residence in a Latinx enclave and end-induction minimal residual disease positivity among children with acute lymphoblastic leukemia. Pediatr Hematol Oncol 2022; 39:650-657. [PMID: 35262447 PMCID: PMC9458766 DOI: 10.1080/08880018.2022.2047850] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/31/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Racial and ethnic inequities in survival persist for children with acute lymphoblastic leukemia (ALL). In the US, there are strong associations between SES, race/ethnicity, and place of residence. This is evidenced by ethnic enclaves: neighborhoods with high concentrations of ethnic residents, immigrants, and language isolation. The Latinx enclave index (LEI) can be used to investigate how residence in a Latinx enclave is associated with health outcomes. We studied the association between LEI score and minimal residual disease (MRD) in 142 pediatric ALL patients treated at Texas Children's Hospital. LEI score was associated with end-induction MRD positivity (OR per unit increase 1.63, CI 1.12-2.46). There was also a significant trend toward increased odds of MRD positivity among children living in areas with the highest enclave index scores. MRD positivity at end of induction is associated with higher incidence of relapse and lower overall survival among children with ALL; future studies are needed to elucidate the exact causes of these findings and to improve ALL outcomes among children residing within Latinx enclaves.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2022.2047850.
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Affiliation(s)
- Joshua P Muñiz
- Department of Internal Medicine and Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John P Woodhouse
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Amy E Hughes
- Department of Population and Data Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sandi L Pruitt
- Department of Population and Data Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karen R Rabin
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Michael E Scheurer
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Philip J Lupo
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremy M Schraw
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
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24
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Thompson EL, Preston SM, Francis JKR, Rodriguez SA, Pruitt SL, Blackwell JM, Tiro JA. Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey. JMIR Pediatr Parent 2022; 5:e38297. [PMID: 36103216 PMCID: PMC9520398 DOI: 10.2196/38297] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. OBJECTIVE This study aimed to examine the association between parents' perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. METHODS Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. RESULTS Of the 1192 respondents, 44.7% (n=533) had an HPV-vaccinated child, 38.8% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be "undecided/not wanting the vaccine" if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95% CI 0.62-0.88; P<.001). CONCLUSIONS Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions.
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Affiliation(s)
- Erika L Thompson
- Department of Biostatistics & Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Sharice M Preston
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, United States.,Department of Health Promotion & Behavioral Science, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center; Children's Health, Dallas, TX, United States
| | - Serena A Rodriguez
- Department of Health Promotion & Behavioral Science, University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, United States
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - James-Michael Blackwell
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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25
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Tavakkoli A, Pruitt SL, Hoang AQ, Zhu H, Hughes AE, McKey TA, Elmunzer BJ, Kwon RS, Murphy CC, Singal AG. Ethnic Disparities in Early-Onset Gastric Cancer: A Population-Based Study in Texas and California. Cancer Epidemiol Biomarkers Prev 2022; 31:1710-1719. [PMID: 35732290 PMCID: PMC9444918 DOI: 10.1158/1055-9965.epi-22-0210] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Incidence rates of gastric cancer are increasing in young adults (age <50 years), particularly among Hispanic persons. We estimated incidence rates of early-onset gastric cancer (EOGC) among Hispanic and non-Hispanic White persons by census tract poverty level and county-level metro/nonmetro residence. METHODS We used population-based data from the California and Texas Cancer Registries from 1995 to 2016 to estimate age-adjusted incidence rates of EOGC among Hispanic and non-Hispanic White persons by year, sex, tumor stage, census tract poverty level, metro versus nonmetro county, and state. We used logistic regression models to identify factors associated with distant stage diagnosis. RESULTS Of 3,047 persons diagnosed with EOGC, 73.2% were Hispanic White. Incidence rates were 1.29 [95% confidence interval (CI), 1.24-1.35] and 0.31 (95% CI, 0.29-0.33) per 100,000 Hispanic White and non-Hispanic White persons, respectively, with consistently higher incidence rates among Hispanic persons at all levels of poverty. There were no statistically significant associations between ethnicity and distant stage diagnosis in adjusted analysis. CONCLUSIONS There are ethnic disparities in EOGC incidence rates that persist across poverty levels. IMPACT EOGC incidence rates vary by ethnicity and poverty; these factors should be considered when assessing disease risk and targeting prevention efforts.
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Affiliation(s)
- Anna Tavakkoli
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas,Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas,Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas,Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas
| | - Anh Q. Hoang
- Natural Sciences and Mathematics, The University of Texas at Dallas, Dallas, Texas
| | - Hong Zhu
- Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas
| | - Amy E Hughes
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas,Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas
| | - Thomas A. McKey
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas
| | - B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Richard S. Kwon
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas,Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas,Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas
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26
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Murphy CC, Paskett ED, Pruitt SL. The Influence of Place and Geography on Outcomes Across the Cancer Continuum. Gastroenterology 2022; 163:369-371. [PMID: 35671802 DOI: 10.1053/j.gastro.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 12/02/2022]
Affiliation(s)
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center and, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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Perez M, Murphy CC, Pruitt SL, Rashdan S, Rahimi A, Gerber DE. Potential Impact of Revised NCI Eligibility Criteria Guidance: Prior Malignancy Exclusion in Breast Cancer Clinical Trials. J Natl Compr Canc Netw 2022; 20:792-799.e4. [PMID: 35830895 PMCID: PMC9906999 DOI: 10.6004/jnccn.2022.7017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/01/2022] [Accepted: 03/31/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many individuals with cancer have survived a prior cancer and for this reason may have been excluded from clinical trials. Recent NCI guidance recommends including these individuals, especially when the risk of the prior malignancy interfering with either safety or efficacy endpoints is very low. Using breast cancer as an example, we determined the potential effect this policy change may have on clinical trial accrual. PATIENTS AND METHODS We reviewed protocols of NCI-sponsored breast cancer clinical trials activated in 1991 through 2016. We quantified prevalence of prior cancer-related exclusion criteria and assessed the association with trial characteristics using Fisher's exact tests. Using SEER data, we estimated the prevalence and timing of prior primary (nonbreast) cancer diagnoses among patients with breast cancer. RESULTS Among 87 clinical trials (total target enrollment, 137,253 patients), 77% excluded individuals with prior cancer, most commonly (79%) within the preceding 5 years. Among trials with radiographic response or toxicity endpoints, 69% excluded prior cancer. In SEER data, the prevalence of a prior (nonbreast) cancer diagnosis ranged from 5.7% to 7.7%, depending on breast cancer stage, of which 39% occurred within 5 years of the incident breast cancer. For trials excluding prior cancer, the estimated proportion of patients excluded for this reason ranged from 1.3% to 5.8%, with the estimated number of excluded patients ranging from 1 to 288. CONCLUSIONS More than three-fourths of NCI-sponsored breast cancer clinical trials exclude patients with prior cancer, including almost 70% of trials with response or toxicity endpoints. Given that >5% of patients with breast cancer have a history of prior cancer, in large phase III trials this practice may exclude hundreds of patients. Following recent NCI eligibility guidance, the inclusion of patients with prior cancer on breast cancer trials may have a meaningful impact on accrual.
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Affiliation(s)
- Matthew Perez
- School of Medicine, UT Southwestern Medical Center, Dallas TX
| | - Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston TX
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX
| | - Sawsan Rashdan
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - Asal Rahimi
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - David E. Gerber
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
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Sok P, Brown AL, Taylor OA, Bernhardt MB, Bernini JC, Erana RA, Griffin T, Heym K, Huynh VT, Klesse L, Ludwig K, Pruitt SL, Rabin KR, Scheurer ME, Lupo PJ. Abstract 3633: Disparities in relapse among a large multi-ethnic population of children diagnosed with acute lymphoblastic leukemia (ALL): A report from the Reducing Ethnic Disparities in Acute Leukemia (REDIAL) Consortium. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3633] [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
Introduction: While end-induction minimal residual disease (MRD) is the strongest prognostic factor for relapsed ALL, approximately half of all relapses occur in children who are MRD negative. Latino ethnicity is also a risk factor for relapse. To further explore these associations, we conducted an interim analysis of risk factors for relapse in a large multi-ethnic population of children diagnosed with ALL.
Methods: The REDIAL Consortium includes patients diagnosed with ALL at six major pediatric cancer centers in the Southwestern U.S. The study period was 2004 to 2018, and we included individuals who were 1-23 years of age when diagnosed with ALL. Time to relapse was defined as time from ALL diagnosis to the initial relapse event, with individuals censored at date of death, last follow-up, or bone marrow transplant. Demographic and clinical factors evaluated included race/ethnicity (Latino, non-Latino Black, non-Latino White, non-Latino other), sex, age at diagnosis (1-5, 6-10, 11-15, >15 years), ALL immunophenotype (B-cell, T-cell), National Cancer Institute (NCI) risk group, central nervous system involvement, enrollment on a Children’s Oncology Group clinical trial, end-induction disease failure, and end-induction bone marrow flow cytometric MRD. Cox proportional hazards models were used to calculate adjusted hazards ratios (HRs) and 95% confidence intervals (CIs). Analyses were further stratified based on end-induction MRD status (positive ≥0.01%, negative <0.01%).
Results: Overall, there were 1,710 ALL patients with a median age at diagnosis of 5 years (interquartile range: 3-11 years). The majority of patients were Latino (60.1%) and male (56.9%). Of the 379 MRD-positive patients, 74 (19.5%) relapsed, compared to 138 of 1,233 (11.2%) MRD-negative patients (p<0.0001). In adjusted models, factors associated with a greater risk of relapse included MRD positivity (HR=1.72, 95% CI: 1.26-2.36), older age at diagnosis (>15 vs. 1-5 years, HR=1.98, 95% CI: 1.19-3.29), and NCI high-risk group (HR=1.74, 95% CI: 1.20-2.52), while patients enrolled on a clinical trial were less likely to relapse (HR=0.76, 95% CI: 0.57-0.99). Among MRD-positive patients, Latinos were less likely to relapse (HR=0.60, 95% CI: 0.33-0.99) compared to non-Latino Whites, whereas Latinos who were MRD negative were more likely to relapse (HR=1.68, 95% CI: 1.09-2.59).
Conclusion: In a large contemporary multi-ethnic cohort of >1,700 children with ALL, we observed significant disparities in relapse by MRD status, age at diagnosis, NCI risk group, clinical trial enrollment, and race/ethnicity. Notably, nearly 65% of relapse events occurred in MRD-negative patients. Further analyses are ongoing in REDIAL to evaluate the impact of other factors including cytogenetics and novel biomarkers of relapse.
Citation Format: Pagna Sok, Austin L. Brown, Olga A. Taylor, M. Brooke Bernhardt, Juan C. Bernini, Rodrigo A. Erana, Timothy Griffin, Kenneth Heym, Van T. Huynh, Laura Klesse, Kathleen Ludwig, Sandi L. Pruitt, Karen R. Rabin, Michael E. Scheurer, Philip J. Lupo. Disparities in relapse among a large multi-ethnic population of children diagnosed with acute lymphoblastic leukemia (ALL): A report from the Reducing Ethnic Disparities in Acute Leukemia (REDIAL) Consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3633.
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Affiliation(s)
- Pagna Sok
- 1Baylor College of Medicine, Houston, TX
| | | | | | | | | | | | | | - Kenneth Heym
- 2Cook Children's Health Care System, Fort Worth, TX
| | | | - Laura Klesse
- 4The University of Texas Southwesetern Medical Center, Dallas, TX
| | - Kathleen Ludwig
- 4The University of Texas Southwesetern Medical Center, Dallas, TX
| | - Sandi L. Pruitt
- 4The University of Texas Southwesetern Medical Center, Dallas, TX
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Muniz JP, Woodhouse JP, Hughes AE, Pruitt SL, Rabin KR, Scheurer ME, Lupo PJ, Schraw JM. Abstract 3671: Association between residence in a Hispanic enclave and end-induction minimal residual disease among children with acute lymphoblastic leukemia in Texas. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3671] [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: Acute lymphoblastic leukemia (ALL) remains a leading cause of death in children and adolescents. We have demonstrated that Hispanic enclaves - neighborhoods with high proportions of Spanish-speaking residents, recent immigrants, and ethnic-specific businesses - are associated with inferior overall survival in children with ALL. However, associations of enclaves with other outcomes remain poorly understood. In the present study, our objective was to determine whether residence in an enclave was associated with end-induction minimal residual disease (MRD), a strong predictor of ALL mortality.
Methods: This was a retrospective study of N=142 children aged 0-18 years, treated at Texas Children’s Hospital (Houston, TX) from 2007-2018. MRD was defined as ≥0.01% leukemic blasts in bone marrow at day 29 of therapy. We used the 2010 census tract geography and a modified version of the Hispanic enclave index to identify enclaves. We assigned an enclave index score to each census tract, computed quartiles based on the statewide distribution, and mapped children to quartiles based on address at diagnosis (Q1: least ethnically distinct neighborhoods; Q4: most ethnically distinct neighborhoods). Data on sex, self-reported race/ethnicity, National Cancer Institute (NCI) risk group, primary language, and ALL cytogenetics were abstracted from electronic health records. Cytogenetics were considered either unfavorable (BCR-ABL1 fusion, KMT2A rearrangement, hypodiploidy, or intrachromosomal amplification of chromosome 21) or favorable (ETV6-RUNX1 fusion, double trisomies of chromosomes 4 and 10)/neutral (neither favorable nor unfavorable). We estimated the odds ratio (OR) and 95% confidence interval (95% CI) of MRD according to enclave index score using logistic regression.
Results: Neither individual ethnicity nor primary language varied by MRD status, but a greater proportion of MRD-positive children lived in the most ethnically distinct neighborhoods (53% vs. 36%, p=0.04). Enclave index score was associated with MRD after adjusting for sex, NCI risk group, and cytogenetics (OR 1.57 per quartile increment, 95% CI 1.09-2.33). We also observed non-significantly increased odds of MRD among children in Q3 (OR 1.53, 95% CI 0.41-6.55) and Q4 (OR 2.84, 0.83-11.58) relative to Q1.
Conclusions: We found that residence in a Hispanic enclave was associated with MRD in children with ALL. Neither ethnicity nor primary language differed by MRD status, suggesting that these did not confound the association with enclave index score. Neighborhood factors may influence early treatment outcomes in ALL, and children living in Hispanic enclaves may constitute a high-risk population.
Citation Format: Joshua P. Muniz, John P. Woodhouse, Amy E. Hughes, Sandi L. Pruitt, Karen R. Rabin, Michael E. Scheurer, Philip J. Lupo, Jeremy M. Schraw. Association between residence in a Hispanic enclave and end-induction minimal residual disease among children with acute lymphoblastic leukemia in Texas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3671.
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Affiliation(s)
| | | | - Amy E. Hughes
- 2University of Texas Southwestern Medical Center, Dallas, TX
| | - Sandi L. Pruitt
- 2University of Texas Southwestern Medical Center, Dallas, TX
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Brown AL, Harris RD, Taylor OA, Bernhardt MB, Bernini JC, Erana RA, Griffin T, Heym K, Huynh VT, Ludwig K, Meoded A, Pruitt SL, Lupo PJ, Rabin KR, Scheurer ME. Abstract 3636: Ethnic disparities in methotrexate neurotoxicity during pediatric acute lymphoblastic leukemia therapy: A report from the Reducing Ethnic Disparities in Acute Leukemia (REDIAL) Consortium. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3636] [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
Introduction: Methotrexate (MTX) is a key component of curative chemotherapy for pediatric acute lymphoblastic leukemia (ALL). However, delivery of MTX is often interrupted by dose-limiting acute neurotoxicity, which manifests as seizures, stroke-like symptoms, or altered mental status. Because incidence and risk factors for MTX neurotoxicity are poorly defined, we evaluated clinical and demographic predictors of MTX neurotoxicity using the multi-ethnic REDIAL Consortium.
Methods: The REDIAL cohort includes pediatric patients diagnosed with ALL at six treatment centers in the southwestern U.S. This interim analysis evaluated 756 patients age 1-21 years diagnosed with B-ALL (2005-2018). Electronic health records were reviewed to determine race/ethnicity (Latino, non-Latino White, non-Latino Black, or Other), body mass index, sex, age, and intravenous (IV) MTX dose. Applying Ponte di Legno criteria, acute MTX neurotoxicity was defined as neurologic episodes occurring <21 days from intrathecal or IV MTX, which resulted in MTX treatment modifications. The proportion of patients who experienced MTX neurotoxicity and corresponding 95% confidence interval (CI) was calculated overall and within the induction, post-induction, and maintenance treatment phases. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) for the association between clinical factors and MTX neurotoxicity.
Results: The study population was 56.6% Latino, 52.8% male, 41.4% treated with >5g/m2 IV MTX, and diagnosed at a median age of 5 years. Overall, 15.5% (95% CI: 12.9-18.3%) of patients experienced neurotoxic events (n=117), including 1.9% (n=14, 95% CI: 1.0-3.1%) during induction, 13.0% (n=98, 95% CI: 10.7-15.6%) during post-induction, and 0.7% (n=5, 95% CI: 0.2-1.5%) during maintenance therapy. Ethnic differences were not statistically significant during induction or maintenance phases. Compared to non-Latinos, post-induction neurotoxicity was significantly more frequent among Latinos (aOR = 2.87, 95% CI: 1.68-5.10), with disparities observed during consolidation, interim maintenance and delayed intensification phases. Exposure to >5g/m2 IV MTX (aOR = 2.16, 95% CI: 1.08-3.24) and older age at diagnosis (aOR = 1.16, 95% CI: 1.08-1.24) were also associated with a significantly more post-induction neurotoxicity. No factors evaluated were significantly associated with neurotoxicity during induction and maintenance therapy.
Conclusions: MTX neurotoxicity disproportionally affects Latino children during ALL post-induction therapy. Additional work is warranted to identify risk factors for neurotoxicity during induction and maintenance therapy as well as the specific clinical and host biological factors responsible for post-induction ethnic differences in MTX neurotoxicity.
Citation Format: Austin L. Brown, Rachel D. Harris, Olga A. Taylor, Melanie B. Bernhardt, Juan C. Bernini, Rodrigo A. Erana, Timothy Griffin, Kenneth Heym, Van T. Huynh, Kathleen Ludwig, Avner Meoded, Sandi L. Pruitt, Philip J. Lupo, Karen R. Rabin, Michael E. Scheurer. Ethnic disparities in methotrexate neurotoxicity during pediatric acute lymphoblastic leukemia therapy: A report from the Reducing Ethnic Disparities in Acute Leukemia (REDIAL) Consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3636.
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Affiliation(s)
| | | | | | | | | | | | | | - Kenneth Heym
- 2Cook Children’s Health Care System, Fort Worth, TX
| | | | - Kathleen Ludwig
- 4The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Sandi L. Pruitt
- 4The University of Texas Southwestern Medical Center, Dallas, TX
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Pruitt SL, Tiro JA, Kepka D, Henry K. Missed Vaccination Opportunities Among U.S. Adolescents by Area Characteristics. Am J Prev Med 2022; 62:538-547. [PMID: 35125272 DOI: 10.1016/j.amepre.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A total of 3 vaccines are recommended for U.S. adolescents: tetanus, diphtheria, and acellular pertussis; meningococcal conjugate; and human papillomavirus. To understand the disparities in vaccine availability and hesitancy, adolescent-, household-, and area-level characteristics associated with patterns of vaccine coverage are described. METHODS In 2020-2021, the authors generated national estimates among 8 possible combinations of vaccine coverage and identified the associated characteristics using 2015-2017 National Immunization Survey-Teen for male and female adolescents aged 13-17 years (N=63,299) linked to area (ZIP code) characteristics. Next, the factors associated with a missed opportunity for human papillomavirus vaccine (i.e., receipt of tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only compared with coverage of all the 3 vaccines) were identified using logistic regression. RESULTS Most U.S. adolescents received all the 3 vaccines (42.9%) or tetanus, diphtheria, and acellular pertussis and meningococcal conjugate only (32.1%); fewer received no vaccines (7.7%) or tetanus, diphtheria, and acellular pertussis only (6.6%); and the remainder received some combination of 1-2 vaccines. Missed opportunities for human papillomavirus vaccination were more likely among adolescents who were male, were of White race, were uninsured, were in middle-income households, and were living in rural areas and were less likely among adolescents who were older, who were Medicaid insured, whose parents completed surveys in Spanish, who were in poverty-level households, and who were living in high-poverty areas. CONCLUSIONS A substantial number of U.S. adolescents are not fully vaccinated, and coverage varies by vaccine type, population, and place. Providers should routinely stock all the 3 vaccines and promote simultaneous, same-day vaccination to avoid missed vaccine opportunities. More research and interventions are needed to understand and modify patient, provider, payer, vaccine supply/storage, or other reasons for suboptimal coverage of all the recommended vaccines.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deanna Kepka
- College of Nursing, The University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kevin Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, Pennsylvania; Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Ibekwe LN, Fernández-Esquer ME, Pruitt SL, Ranjit N, Fernández ME. Abstract PO-074: The impact of perceived racial discrimination and racial residential segregation on cancer screening among African American women: A multilevel, longitudinal analysis of 2-1-1 Texas callers. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-074] [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] Open
Abstract
Abstract
Although racism is increasingly being studied as an important contributor to racial health disparities, its relation to cancer-related outcomes among African Americans remains unclear. The purpose of this study was to help clarify the relation between two indicators of racism—perceived racial discrimination and racial residential segregation—and cancer screening. We conducted a multilevel, longitudinal study among a medically underserved population of African Americans in Texas. We assessed discrimination using the Experiences of Discrimination Scale and segregation using the Location Quotient for Racial Residential Segregation. The outcome examined was “any cancer screening completion” (Pap test, mammography, and/or colorectal cancer screening) at follow-up (3–10 months post-baseline). We tested hypothesized relations using multilevel logistic regression. We also conducted interaction and stratified analyses to explore whether discrimination modified the relation between segregation and screening completion. We found a significant positive relation between discrimination and screening and a non-significant negative relation between segregation and screening. Preliminary evidence suggests that discrimination modifies the relation between segregation and screening in that segregation is positively related to screening when no discrimination is reported but negatively related to screening when discrimination is reported. Conclusion: Racism has a nuanced association with cancer screening among African Americans. Perceived racial discrimination and racial residential segregation should be considered jointly, rather than independently, to better understand their influence on cancer screening behavior.
Citation Format: Lynn N. Ibekwe, Maria Eugenia Fernández-Esquer, Sandi L. Pruitt, Nalini Ranjit, Maria E. Fernández. The impact of perceived racial discrimination and racial residential segregation on cancer screening among African American women: A multilevel, longitudinal analysis of 2-1-1 Texas callers [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-074.
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Affiliation(s)
- Lynn N. Ibekwe
- 1The University of Texas Health Science Center at Houston School of Public Health, Houston, TX,
| | | | - Sandi L. Pruitt
- 2The University of Texas Southwestern Medical Center, Dallas, TX,
| | - Nalini Ranjit
- 3The University of Texas Health Science Center at Houston School of Public Health – Austin Regional Campus, Austin, TX
| | - Maria E. Fernández
- 1The University of Texas Health Science Center at Houston School of Public Health, Houston, TX,
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Francis JK, Rodriguez SA, Dorsey O, Blackwell JM, Balasubramanian BA, Kale N, Day P, Preston SM, Thompson EL, Pruitt SL, Tiro JA. Provider perspectives on communication and dismissal policies with HPV vaccine hesitant parents. Prev Med Rep 2021; 24:101562. [PMID: 34976628 PMCID: PMC8683895 DOI: 10.1016/j.pmedr.2021.101562] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022] Open
Abstract
Providers (29%) experience HPV-specific vaccine hesitancy from parents. Providers feel least confident in responding to families’ religious beliefs. Some providers (25%) agree with dismissal policies for families refusing vaccines.
Parental vaccine hesitancy is a growing concern. Less is known about provider or practice characteristics that encounter HPV-specific vaccine-hesitant parents, the providers’ confidence in responding to HPV vaccine concerns, and the attitudes and use of vaccine dismissal policies (i.e., removing patients from the practice). North Texas providers completed an online survey. Dependent variables assessed: (1) percentage of HPV vaccine-hesitant parents encountered in practice defined as substantive, or high (≥11%, or among more than one out of ten adolescent patient encounters) versus low (≤10%) levels; (2) confidence in responding to 11 HPV vaccine concerns; (3) attitudes and use of vaccine dismissal policies. Chi-square and Fisher’s exact tests were conducted. Among 156 providers, 29% reported high HPV vaccine hesitancy (≥11% of patient population). Overall, providers reported being “very confident” in addressing vaccine concerns (mean: 3.37 out of 4, SD: 0.57). Mean confidence scores were significantly higher for white (vs. non-white) providers and for pediatricians (vs. family practitioners). Providers were least confident in responding to parents’ religious/personal beliefs (69%). Some providers (25%) agreed with policies that dismissed vaccine-hesitant parents after repeated counseling attempts. More providers used dismissal policies for childhood (19%) than adolescent (10%) immunizations. Provider communication training should include parental religious/personal beliefs to effectively address HPV vaccine hesitancy. Other regions should examine their HPV-specific vaccine hesitancy levels to understand how the use of dismissal policies might vary between adolescent and childhood immunizations.
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Ibekwe LN, Fernández-Esquer ME, Pruitt SL, Ranjit N, Fernández ME. Racism and Cancer Screening among Low-Income, African American Women: A Multilevel, Longitudinal Analysis of 2-1-1 Texas Callers. Int J Environ Res Public Health 2021; 18:11267. [PMID: 34769784 PMCID: PMC8583140 DOI: 10.3390/ijerph182111267] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022]
Abstract
Although racism is increasingly being studied as an important contributor to racial health disparities, its relation to cancer-related outcomes among African Americans remains unclear. The purpose of this study was to help clarify the relation between two indicators of racism-perceived racial discrimination and racial residential segregation-and cancer screening. We conducted a multilevel, longitudinal study among a medically underserved population of African Americans in Texas. We assessed discrimination using the Experiences of Discrimination Scale and segregation using the Location Quotient for Racial Residential Segregation. The outcome examined was "any cancer screening completion" (Pap test, mammography, and/or colorectal cancer screening) at follow-up (3-10 months post-baseline). We tested hypothesized relations using multilevel logistic regression. We also conducted interaction and stratified analyses to explore whether discrimination modified the relation between segregation and screening completion. We found a significant positive relation between discrimination and screening and a non-significant negative relation between segregation and screening. Preliminary evidence suggests that discrimination modifies the relation between segregation and screening. Racism has a nuanced association with cancer screening among African Americans. Perceived racial discrimination and racial residential segregation should be considered jointly, rather than independently, to better understand their influence on cancer screening behavior.
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Affiliation(s)
- Lynn N. Ibekwe
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Maria Eugenia Fernández-Esquer
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Nalini Ranjit
- Michael and Susan Dell Center for Healthy Living, School of Public Health, The University of Texas Health Science Center at Houston–Austin Regional Campus, Austin, TX 78701, USA;
| | - Maria E. Fernández
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (M.E.F.-E.); (M.E.F.)
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Murphy CC, Lupo PJ, Roth ME, Winick NJ, Pruitt SL. Disparities in Cancer Survival Among Adolescents and Young Adults: A Population-Based Study of 88 000 Patients. J Natl Cancer Inst 2021; 113:1074-1083. [PMID: 33484568 DOI: 10.1093/jnci/djab006] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/23/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYA, aged 15-39 years) diagnosed with cancer comprise a growing, yet understudied, population. Few studies have examined disparities in cancer survival in underserved and diverse populations of AYA. METHODS Using population-based data from the Texas Cancer Registry, we estimated 5-year relative survival of common AYA cancers and examined disparities in survival by race and ethnicity, neighborhood poverty, urban or rural residence, and insurance type. We also used multivariable Cox proportional hazards regression models to examine associations of race or ethnicity, neighborhood poverty, urban or rural residence, and insurance type with all-cause mortality. RESULTS We identified 55 316 women and 32 740 men diagnosed with invasive cancer at age 15-39 years between January 1, 1995, and December 31, 2016. There were disparities in relative survival by race and ethnicity, poverty, and insurance for many cancer types. Racial and ethnic disparities in survival for men with non-Hodgkin lymphoma (74.5% [95% confidence interval (CI) = 72.1% to 76.7%] White vs 57.0% [95% CI = 51.9% to 61.8%] Black) and acute lymphocytic leukemia (66.5% [95% CI = 61.4% to 71.0%] White vs 44.4% [95% CI = 39.9% to 48.8%] Hispanic) were striking, and disparities remained even for cancers with excellent prognosis, such as testicular cancer (96.6% [95% CI = 95.9% to 97.2%] White vs 88.7% [95% CI = 82.4% to 92.8%] Black). In adjusted analysis, being Black or Hispanic, living in high-poverty neighborhoods, and having Medicaid, other government insurance, or no insurance at diagnosis were associated with all-cause mortality in both women and men (all 2-sided P < .01). CONCLUSIONS Our study adds urgency to well-documented disparities in cancer survival in older adults by demonstrating persistent differences in relative survival and all-cause mortality in AYAs. Findings point to several areas of future research to address disparities in this unique population of cancer patients.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population and Data Sciences, Internal Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naomi J Winick
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandi L Pruitt
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Pruitt SL, Gerber DE, Zhu H, Heitjan DF, Maddineni B, Xiong D, Singal AG, Tavakkoli A, Halm EA, Murphy CC. Survival of patients newly diagnosed with colorectal cancer and with a history of previous cancer. Cancer Med 2021; 10:4752-4767. [PMID: 34190429 PMCID: PMC8290226 DOI: 10.1002/cam4.4036] [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] [Received: 03/12/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with previous cancer are often excluded from clinical trials despite limited evidence about their prognosis. We examined the effect of previous cancer on overall and colorectal cancer (CRC)-specific survival of patients newly diagnosed with CRC. This population-based cohort study from the U.S.A. included patients aged ≥66 years and diagnosed with CRC between 2005 and 2015 in linked Surveillance, Epidemiology, and End Results-Medicare data. We estimated the stage-specific effects of a previous cancer on overall survival using Cox regression and on CRC-specific survival using competing risk regression. We also examined the effect of previous cancer type, timing, and stage on overall survival. Of 112,769 patients, 14.1% were previously diagnosed with another cancer--commonly prostate (32.9%) or breast (19.4%) cancer, with many (47.1%) diagnosed <5 years of CRC. For all CRC stages except IV, in which there was no difference, patients with previous cancer (vs. without) had worse overall survival. However, patients with previous cancer had improved CRC-specific survival. Overall survival for those with stage 0-III CRC varied by previous cancer type, timing, and stage; for example, patients with previous melanoma had overall survival equivalent to those with no previous cancer. Our results indicate that, in general, CRC patients with previous cancer have worse overall survival but superior CRC-specific survival. Given their equivalent survival to those without previous cancer, patients with previous melanoma and those with stage IV CRC with any type of previous cancer should be eligible to participate in clinical trials.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - David E Gerber
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hong Zhu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Daniel F Heitjan
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Bhumika Maddineni
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Danyi Xiong
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Amit G Singal
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anna Tavakkoli
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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Pruitt SL, Zhu H, Heitjan DF, Rahimi A, Maddineni B, Tavakkoli A, Halm EA, Gerber DE, Xiong D, Murphy CC. Survival of women diagnosed with breast cancer and who have survived a previous cancer. Breast Cancer Res Treat 2021; 187:853-865. [PMID: 33620590 PMCID: PMC8318112 DOI: 10.1007/s10549-021-06122-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Many women diagnosed with breast cancer have survived previous cancer; yet little is known about the impact of previous cancer on overall and cancer-specific survival. METHODS This population-based cohort study using SEER-Medicare data included women (age ≥ 66 years) diagnosed with breast cancer between 2005 and 2015. Separately by breast cancer stage, we estimated effect of previous cancer on overall survival using Cox regression and on cause-specific survival using competing risk regression; all survival analyses adjusted for covariates. RESULTS Of 138,576 women diagnosed with breast cancer, 8% had a previous cancer of another organ site, most commonly colorectal or uterine cancer or melanoma. Many of these women (46.3%) were diagnosed within 5 years of breast cancer. For all breast cancer stages except IV wherein there was no difference, women with vs. without previous cancer had worse overall survival. This survival disadvantage was driven by deaths due to the previous cancer and other causes. In contrast, women with previous cancer generally had favorable breast-cancer-specific survival, although this varied by stage. Overall survival varied by previous cancer type, timing, and stage; previous lung cancer, cancer diagnosed within 1 year of incident breast cancer, and previous cancer at a distant stage were associated with the worst survival. In contrast, women with a previous melanoma had equivalent overall survival to women without previous cancer. CONCLUSION We observed variable impact of previous cancer on overall and breast-cancer-specific survival depending on breast cancer stage at diagnosis and the type, timing, and stage of previous cancer.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Hong Zhu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Daniel F Heitjan
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Asal Rahimi
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bhumika Maddineni
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Anna Tavakkoli
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David E Gerber
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Danyi Xiong
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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Bevins J, Bhulani N, Goksu SY, Sanford NN, Gao A, Ahn C, Paulk ME, Terauchi S, Pruitt SL, Tavakkoli A, Rhodes RL, Ali Kazmi SM, Beg MS. Early Palliative Care Is Associated With Reduced Emergency Department Utilization in Pancreatic Cancer. Am J Clin Oncol 2021; 44:181-186. [PMID: 33710133 PMCID: PMC8062302 DOI: 10.1097/coc.0000000000000802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/25/2022]
Abstract
OBJECTIVES Most patients with pancreatic cancer have high symptom burden and poor outcomes. Palliative care (PC) can improve the quality of care through expert symptom management, although the optimal timing of PC referral is still poorly understood. We aimed to assess the association of early PC on health care utilization and charges of care for pancreatic cancer patients. MATERIALS AND METHODS We selected patients with pancreatic cancer diagnosed between 2000 and 2009 who received at least 1 PC encounter using the Surveillance, Epidemiology, and End Results (SEER)-Medicare. Patients who had unknown follow-up were excluded. We defined "early PC" if the patients received PC within 30 days of diagnosis. RESULTS A total of 3166 patients had a PC encounter; 28% had an early PC. Patients receiving early PC were more likely to be female and have older age compared with patients receiving late PC (P<0.001). Patients receiving early PC had fewer emergency department (ED) visits (2.6 vs. 3.0 visits, P=0.004) and lower total charges of ED care ($3158 vs. $3981, P<0.001) compared with patients receiving late PC. Patients receiving early PC also had lower intensive care unit admissions (0.82 vs. 0.98 visits, P=0.006) and total charges of intensive care unit care ($14,466 vs. $18,687, P=0.01). On multivariable analysis, patients receiving early PC were significantly associated with fewer ED visits (P=0.007) and lower charges of ED care (P=0.018) for all patients. CONCLUSIONS Early PC referrals were associated with lower ED visits and ED-related charges. Our findings support oncology society guideline recommendations for early PC in patients with advanced malignancies such as pancreatic cancer.
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Affiliation(s)
- Jack Bevins
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Nizar Bhulani
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Suleyman Yasin Goksu
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Nina Niu Sanford
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Ang Gao
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Chul Ahn
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Mary Elizabeth Paulk
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Palliative Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Stephanie Terauchi
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Palliative Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Anna Tavakkoli
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX
| | - Ramona L. Rhodes
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Geriatric Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Syed Mohammad Ali Kazmi
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Muhammad Shaalan Beg
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
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Pruitt SL, Zhu H, Heitjan D, Gerber DE, Maddineni B, Xiong D, Halm E, Murphy C. Abstract PS11-31: Survival among female breast cancer patients who have survived a previous cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps11-31] [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 A growing number of women newly diagnosed with breast cancer have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. Additional evidence about the survival of this population is needed, so that trial sponsors and investigators can create evidence-based trial eligibility criteria. Among women newly diagnosed with breast cancer, we examined the impact of previous cancer on overall and cancer-specific survival. Methods This population-based cohort study included patients age ≥66 years and diagnosed with breast cancer between 2005-2015 in linked SEER-Medicare data. Separately by breast cancer stage, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression for women with and without previous cancer, adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident breast cancer. Results Of 138,576 women diagnosed with incident breast cancer, 10,822 (8%) had a previous cancer of another organ site. Many of these (n=5,014, 46.3%) were diagnosed ≤5 years of breast cancer. For all breast cancer stages except IV in which there was no significant survival difference, women with vs. without previous cancer had worse overall survival. This survival disadvantage was driven by deaths due to the previous cancer and other causes. In contrast, women with previous cancer generally had favorable breast-cancer specific survival; however this varied somewhat by stage and over time. Conclusions Many women newly diagnosed with breast cancer are already cancer survivors. These women had generally worse overall survival, worse survival from other causes, but their disease-specific survival varied depending on their breast cancer stage and over time.
Citation Format: Sandi L Pruitt, Hong Zhu, Daniel Heitjan, David E Gerber, Bhumika Maddineni, Danyi Xiong, Ethan Halm, Caitlin Murphy. Survival among female breast cancer patients who have survived a previous cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-31.
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Affiliation(s)
| | - Hong Zhu
- UT Southwestern Medical Center, Dallas, TX
| | | | | | | | | | - Ethan Halm
- UT Southwestern Medical Center, Dallas, TX
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Bandera EV, Pruitt SL. Health Equity, Culture, and Cancer-American Society of Preventive Oncology (ASPO)'s 2021 Annual Meeting. Cancer Epidemiol Biomarkers Prev 2021; 30:237-238. [PMID: 33431629 DOI: 10.1158/1055-9965.epi-20-1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Elisa V Bandera
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Sandi L Pruitt
- University of Texas Southwestern Medical Center, Dallas, Texas
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Tavakkoli A, Elmunzer BJ, Waljee AK, Murphy CC, Pruitt SL, Zhu H, Rong R, Kwon RS, Scheiman JM, Rubenstein JH, Singal AG. Survival analysis among unresectable pancreatic adenocarcinoma patients undergoing endoscopic or percutaneous interventions. Gastrointest Endosc 2021; 93:154-162.e5. [PMID: 32531402 PMCID: PMC8786308 DOI: 10.1016/j.gie.2020.05.061] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Most patients with pancreatic cancer are diagnosed at a late stage and are not candidates for surgical resection. Many have jaundice requiring biliary drainage, which can be accomplished using ERCP or percutaneous transhepatic biliary drainage (PTBD). To date, no studies have evaluated the impact of ERCP or PTBD on survival among patients with unresectable pancreatic cancer. The aims of our study were to compare overall survival between patients with unresectable pancreatic cancer receiving ERCP with those receiving PTBD, to compare overall survival between patients who received a biliary intervention (ERCP or PTBD) versus those who received no biliary intervention, and to compare secondary outcomes, such as length of hospital stay and costs, between ERCP and PTBD. METHODS We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare database. Patients with known pancreatic cancer were included if they had a pancreatic head mass and/or evidence of biliary obstruction. We used a time-varying Cox proportional hazards model to estimate overall survival of patients receiving ERCP versus PTBD and overall survival among patients who received a biliary intervention versus no biliary drainage. Secondary outcomes included length of hospital stay, costs, and admissions within 30 days. RESULTS Of 14,808 patients with unresectable pancreatic cancer, 8898 patients (60.0%) underwent biliary drainage and 5910 patients (39.9%) received no biliary intervention. ERCP accounted for most biliary interventions (8271, 93.0%), whereas 623 patients (7.0%) underwent PTBD. In multivariable analysis, ERCP was associated with reduced mortality compared with PTBD (adjusted hazard ratio [aHR], .67; 95% confidence interval [CI], .60-.75). When ERCP or PTBD was compared with no biliary intervention, both procedures were associated with a survival benefit (aHR, .51 [95% CI, .49-.54] and .53 [95% CI, .48-.59], respectively). Compared with patients receiving PTBD, those who underwent ERCP had shorter mean length of hospital stay (7.0 ± 5.7 days vs 9.6 ± 6.6 days, respectively; P < .001) and lower hospital charges ($54,899.25 vs $75,246.00, P < .001) but no significant difference in hospitalization or 30-day readmissions. CONCLUSIONS ERCP is associated with reduced mortality compared with PTBD in pancreatic cancer patients, highlighting the critical role of ERCP in the management of biliary obstruction from pancreatic cancer.
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Affiliation(s)
- Anna Tavakkoli
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Akbar K Waljee
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA; Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; Institute of Healthy Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Michigan Integrated Center for Health Analytics and Medical Prediction, Ann Arbor, Michigan, USA
| | - Caitlin C Murphy
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA; Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas, USA
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA; Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas, USA
| | - Hong Zhu
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA; Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas, USA
| | - Rong Rong
- Simmons Comprehensive Cancer Center, University of Texas Southwestern, Dallas, Texas, USA; Department of Statistical Science, Southern Methodist University, Dallas, Texas, USA
| | - Richard S Kwon
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - James M Scheiman
- Division of Gastroenterology, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Joel H Rubenstein
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA; Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Hughes AE, Lee SC, Eberth JM, Berry E, Pruitt SL. Do mobile units contribute to spatial accessibility to mammography for uninsured women? Prev Med 2020; 138:106156. [PMID: 32473958 PMCID: PMC7388587 DOI: 10.1016/j.ypmed.2020.106156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 03/18/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
Limited spatial accessibility to mammography, and socioeconomic barriers (e.g., being uninsured), may contribute to rural disparities in breast cancer screening. Although mobile mammography may contribute to population-level access, few studies have investigated this relationship. We measured mammography access for uninsured women using the variable two-step floating catchment area (V2SFCA) method, which estimates access at the local level using estimated potential supply and demand. Specifically, we measured supply with mammography machine certifications in 2014 from FDA and brick-and-mortar and mobile facility data from the community-based Breast Screening and Patient Navigation (BSPAN) program. We measured potential demand using Census tract-level estimates of female residents aged 45-74 from 5-year 2012-2016 American Community Survey data. Using the sign test, we compared mammography access estimates based on 3 facility groupings: FDA-certified, program brick-and-mortar only, and brick-and-mortar plus mobile. Using all mammography facilities, accessibility was high in urban Dallas-Ft. Worth, low for the ring of adjacent counties, and high for rural counties outlying this ring. Brick-and-mortar-based estimates were lower for the outlying ring, and mobile-unit contribution to access was observed more in urban tracts. Weak mobile-unit contribution across the study area may indicate suboptimal dispatch of mobile units to locations. Geospatial methods could identify the optimal locations for mobile units, given existing brick-and-mortar facilities, to increase access for underserved areas.
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Affiliation(s)
- Amy E Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Simon C Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Emily Berry
- Moncrief Cancer Center, Fort Worth, TX, USA.
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
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Shariff-Marco S, Gomez SL, Canchola AJ, Fullington H, Hughes AE, Hong Zhu, Pruitt SL. Nativity, ethnic enclave residence, and breast cancer survival among Latinas: Variations between California and Texas. Cancer 2020; 126:2849-2858. [PMID: 32181892 PMCID: PMC7245543 DOI: 10.1002/cncr.32845] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Among Latinas with breast cancer, residence in an ethnic enclave may be associated with survival. However, findings from prior studies are inconsistent. METHODS The authors conducted parallel analyses of California and Texas cancer registry data for adult (aged ≥18 years) Latinas who were diagnosed with invasive breast cancer from 1996 to 2005, with follow-up through 2014. Existing indices applied to tract-level 2000 US Census data were used to measure Latinx enclaves and neighborhood socioeconomic status (nSES). Multivariable Cox proportional hazard models were fit for all-cause and breast cancer-specific survival adjusted for year of diagnosis, patient age, nativity (with multiple imputation), tumor stage, histology, grade, size, and clustering by census tract. RESULTS Among 38,858 Latinas, the majority (61.3% in California and 70.5% in Texas) lived in enclaves. In fully adjusted models for both states, foreign-born women were found to be more likely to die of breast cancer and all causes when compared with US-born women. Living in enclaves and in neighborhoods with higher SES were found to be independently associated with improved survival from both causes. When combined into a 4-level variable, those in low nSES nonenclaves had worse survival for both causes compared with those living in low nSES enclaves and, in the all-cause but not breast cancer-specific models, those in high nSES neighborhoods, regardless of enclave status, had improved survival from all causes. CONCLUSIONS Applying the same methods across 2 states eliminated previously published inconsistent associations between enclave residence and breast cancer survival. Future studies should identify specific protective effects of enclave residence to inform interventions.
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Affiliation(s)
- Salma Shariff-Marco
- Greater Bay Area Cancer Registry, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA
| | - Scarlett Lin Gomez
- Greater Bay Area Cancer Registry, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA
| | - Alison J. Canchola
- Greater Bay Area Cancer Registry, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA
| | - Hannah Fullington
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy E. Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hong Zhu
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, Dallas, Texas, USA
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, Dallas, Texas, USA
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Tavakkoli A, Singal AG, Waljee AK, Elmunzer BJ, Pruitt SL, McKey T, Rubenstein JH, Scheiman JM, Murphy CC. Racial Disparities and Trends in Pancreatic Cancer Incidence and Mortality in the United States. Clin Gastroenterol Hepatol 2020; 18:171-178.e10. [PMID: 31202981 DOI: 10.1016/j.cgh.2019.05.059] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 02/13/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Pancreatic cancer is one of the few cancers in the United States that is increasing in incidence. Little is known about racial disparities in incidence and mortality. We characterized racial disparities in pancreatic cancer incidence and mortality in different locations, time periods, age groups, and disease stages. METHODS We obtained data on the incidence of pancreatic cancer from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results program of cancer registries from 2001 through 2015 on incidence, demographics, tumor characteristics, and population estimates for all 50 states and the District of Columbia. We obtained data on mortality from pancreatic cancer from the National Center for Health Statistics during the same time period. We plotted incidence rates by 10-year age group (30-39 years through 70-79 years and 80 years or older) separately for white and black patients. We calculated incidence and mortality rate ratios with 95% CIs for categories of age and race. To determine racial disparities, we calculated incidence rate ratios (IRR) for black vs white patients and mortality rate ratios by state. RESULTS Disparities in pancreatic cancer incidence and mortality in black vs white patients decreased over 5-year time periods from 2001 through 2015. However, among all age groups, from 2001 through 2015, pancreatic cancer incidence and mortality were higher among blacks than whites (incidence, 24.7 vs 19.4 per 100,000; IRR, 1.28; 95% CI, 1.26-1.29; mortality, 23.3 vs 18.4 per 100,000; IRR, 1.27; 95% CI, 1.26-1.28). Black patients had a higher incidence of distant pancreatic cancer (IRR, 1.32; 95% CI, 1.31-1.34) and a lower incidence of local cancer. Incidence increased in whites and blacks of younger age groups and was most prominent among persons 30-39 years old. Incidence increased by 57% among younger whites (IRR, 1.70; 95% CI, 1.43-2.02) and by 44% among blacks (IRR, 1.47; 95% CI, 1.01-2.15) from 2001 through 2015. Mortality remained stable among blacks and slightly increased among whites during this time period. CONCLUSIONS In the United States, there are racial disparities in pancreatic incidence and mortality that vary with location, patient age, and cancer stage. Further research is needed to identify factors associated with increasing incidence and persistence of racial disparities in pancreatic cancer.
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Affiliation(s)
- Anna Tavakkoli
- Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas.
| | - Amit G Singal
- Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas
| | - Akbar K Waljee
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan; Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan
| | - B Joseph Elmunzer
- Department of Medicine, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina
| | - Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas Texas
| | - Thomas McKey
- Department of Clinical Sciences, University of Texas Southwestern, Dallas, Texas
| | - Joel H Rubenstein
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan
| | - James M Scheiman
- Division of Gastroenterology, University of Virginia, Charlottesville, Virginia
| | - Caitlin C Murphy
- Department of Clinical Sciences, University of Texas Southwestern, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas Texas
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Fernández-Esquer ME, Hughes AE, Pruitt SL. Exposures at day labor corners: using existing georeferenced data to describe features of urban environments. Ann Epidemiol 2019; 39:54-62. [PMID: 31629605 PMCID: PMC6888997 DOI: 10.1016/j.annepidem.2019.09.003] [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: 02/28/2019] [Revised: 08/30/2019] [Accepted: 09/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Latino day laborers are male immigrants from mainly Mexico and Central America who congregate at corners, that is, informal hiring sites, to solicit short-term employment. Studies describing the occupational environment of Latino day laborers traditionally measure jobsite exposures, not corner exposures. We sought to elucidate exposures at corners by describing their demographic, socioeconomic, occupational, business, built, and physical environmental characteristics and by comparing corner characteristics with other locations in a large urban county in Texas. METHODS We used multiple publicly available data sets from the U.S. Census, local tax authority, Google's Nearby Places Application Programming Interface, and Environmental Protection Agency at fine spatial scale to measure 34 characteristics of corners with matched comparison locations. RESULTS Corners were located close to highways, high-traffic intersections, hardware and moving stores, and gas stations. Corners were in neighborhoods with large foreign-born and Latino populations, high rates of limited English proficiency, and high construction-sector employment. CONCLUSIONS Publicly available data sources describe demographic, socioeconomic, occupational, business, built, and physical environment characteristics of urban environments at fine spatial scale. Using these data, we identified unique corner-based exposures experienced by day laborers. Future research is needed to understand how corner environments may influence health for this uniquely vulnerable population.
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Affiliation(s)
| | - Amy E Hughes
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX.
| | - Sandi L Pruitt
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX
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Murphy CC, Gerber DE, Pruitt SL. Prevalence of Prior Cancer Among Persons Newly Diagnosed With Cancer: An Initial Report From the Surveillance, Epidemiology, and End Results Program. JAMA Oncol 2019; 4:832-836. [PMID: 29167866 DOI: 10.1001/jamaoncol.2017.3605] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance The US cancer survivor population is rapidly growing. Cancer survivors are frequently excluded from cancer clinical trials and observational research. Objective To examine prevalence of prior cancer among individuals newly diagnosed with cancer. Design, Setting, and Participants Linked observations across the population-based Surveillance, Epidemiology, and End Results (SEER) program of cancer registries (1975-2013) for 740 990 persons newly diagnosed with cancer from January 2009 through December 2013. Prevalence of prior cancer was estimated by age (<65 years vs ≥65 years) and incident cancer type. Main Outcomes and Measures Prevalence of prior cancer was derived from SEER sequence numbers, which represent the order of all primary reportable tumors diagnosed in a lifetime. Incident cancers were categorized as: (1) first or only primary; (2) second order or higher primary in the same cancer site; and (3) second order or higher primary in a different cancer site. Results Of 765 843 incident cancers diagnosed between 2009 and 2013, 141 021 (18.4%) represented a second order or higher primary cancer. Overall, approximately one-fourth (25.2%) of older (≥65 years) and 11% of younger adults newly diagnosed with cancer had a history of prior cancer. Prevalence of prior cancer ranged from 3.5% to 36.9% according to incident cancer type and age, with most prior cancers diagnosed in a different cancer site. Conclusions and Relevance A substantial proportion of patients diagnosed with incident cancer in the United States have survived a prior cancer. These patients may be excluded from clinical trials and underrepresented in observational research, and little is known about their treatment and survivorship needs. Understanding the nature and impact of prior cancer is critical to improving clinical trial accrual and generalizability, disease outcomes, and patient experience.
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Affiliation(s)
- Caitlin C Murphy
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - David E Gerber
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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McKillop CN, Leonard T, Pruitt SL, Tiro JA. Do traditional economic theories of free riding behavior explain spatial clustering of HPV vaccine uptake? SSM Popul Health 2019; 8:100421. [PMID: 31206005 PMCID: PMC6558301 DOI: 10.1016/j.ssmph.2019.100421] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 10/31/2022] Open
Abstract
Rationale Geographic clusters of low vaccination uptake reduce the population-level efficacy of vaccination programs. However, little is known about the mechanisms that drive geographic patterns in vaccination rates. Traditional economic theory considers vaccination as a classic public good and suggests that free riding-individuals taking advantage of public goods by relying on others' immunization behavior without contributing toward them-is a primary cause of low vaccination rates. However, behavioral economics suggests that free riding does not fully explain observed individual behavior, and the presence of both high and low clusters of vaccination rates suggest that this theory alone does not fully explain geographic patterns of vaccination. Objective We assessed geographic clustering of HPV vaccination uptake and examined the evidence for or against free riding in HPV vaccination decisions. Methods We analyzed HPV vaccination decisions of low-income adolescent females (N = 601) residing in urban neighborhoods in Dallas, Texas, USA during 2011-2012. Spatial econometric models were estimated to assess the relationship between neighborhood vaccination rates and individual vaccination decisions. Results We found a positive and significant relationship between individual HPV vaccination choices and the average neighborhood vaccination rate at the time parents were making vaccine decisions for their adolescent daughters while controlling for neighborhood sorting and other confounders. Conclusion Individuals were more likely to complete the HPV vaccination series when others in their neighborhood had already completed the series. We do not find evidence for free riding in HPV vaccination decisions.
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Affiliation(s)
- Caitlin N McKillop
- Economics Department, State University of New York at Cortland, 28 Graham St, Old Main 136A, Cortland, NY, 13045, United States
| | - Tammy Leonard
- Economics Department, University of Dallas, 1845 E Northgate Drive, Irving, TX, 75062, United States
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
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Tavakkoli A, Singal AG, Waljee AK, Scheiman JM, Murphy CC, Pruitt SL, Xuan L, Kwon RS, Law RJ, Elta GH, Wright-Slaughter P, Valley TS, Kubiliun N, Nathan H, Rubenstein JH, Elmunzer BJ. Regional and racial variations in the utilization of endoscopic retrograde cholangiopancreatography among pancreatic cancer patients in the United States. Cancer Med 2019; 8:3420-3427. [PMID: 31087545 PMCID: PMC6601581 DOI: 10.1002/cam4.2225] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/11/2019] [Accepted: 04/23/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Pancreatic cancer is projected to become the second leading cause of cancer-related deaths by 2030. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as first-line therapy for biliary decompression in pancreatic cancer. The aim of our study was to characterize geographic and racial/ethnic disparities in ERCP utilization among patients with pancreatic cancer. METHODS Retrospective cohort study using the US Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients diagnosed with pancreatic cancer from 2003-2013. The primary outcome was receipt of ERCP, with or without stent placement, vs any non-ERCP biliary intervention. RESULTS Of the 36 619 patients with pancreatic cancer, 37.5% (n = 13 719) underwent an ERCP, percutaneous drainage, or surgical biliary bypass. The most common biliary intervention (82.6%) was ERCP. After adjusting for tumor location and stage, Blacks were significantly less likely to receive ERCP than Whites (aOR 0.84, 95% CI 0.72, 0.97) and more likely to receive percutaneous transhepatic biliary drainage (PTBD) (aOR 1.38, 95% CI 1.14, 1.66). Patients in the Southeast and the West were more likely to receive ERCP than those in the Northeast (Southeast aOR 1.21, 95% CI 1.04, 1.40; West aOR 1.16, 95% CI 1.01, 1.32). CONCLUSION Racial/ethnic and geographic disparities in access to biliary interventions including ERCP exist for patients with pancreatic cancer in the United States. Our results highlight the need for further research and policies to improve access to appropriate biliary intervention for all patients.
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Affiliation(s)
- Anna Tavakkoli
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Amit G Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Akbar K Waljee
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan.,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan
| | - James M Scheiman
- Division of Gastroenterology, University of Virginia, Charlottesville, Virginia
| | - Caitlin C Murphy
- Department of Clinical Sciences, University of Texas Southwestern, Dallas, Texas
| | - Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern, Dallas, Texas
| | - Lei Xuan
- Department of Clinical Sciences, University of Texas Southwestern, Dallas, Texas
| | - Richard S Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Grace H Elta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | | | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Nisa Kubiliun
- Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Hari Nathan
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Joel H Rubenstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
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Hughes AE, Tiro JA, Balasubramanian BA, Skinner CS, Pruitt SL. Social Disadvantage, Healthcare Utilization, and Colorectal Cancer Screening: Leveraging Longitudinal Patient Address and Health Records Data. Cancer Epidemiol Biomarkers Prev 2018; 27:1424-1432. [PMID: 30135072 PMCID: PMC6279539 DOI: 10.1158/1055-9965.epi-18-0446] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/01/2018] [Revised: 07/11/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Social disadvantage predicts colorectal cancer outcomes across the cancer care continuum for many populations and places. For medically underserved populations, social disadvantage is likely intersectional-affecting individuals at multiple levels and through membership in multiple disadvantaged groups. However, most measures of social disadvantage are cross-sectional and limited to race, ethnicity, and income. Linkages between electronic health records (EHR) and external datasets offer rich, multilevel measures that may be more informative. METHODS We identified urban safety-net patients eligible and due for colorectal cancer screening from the Parkland-UT Southwestern PROSPR cohort. We assessed one-time screening receipt (via colonoscopy or fecal immunochemical test) in the 18 months following cohort entry via the EHR. We linked EHR data to housing and Census data to generate measures of social disadvantage at the parcel- and block-group level. We evaluated the association of these measures with screening using multilevel logistic regression models controlling for sociodemographics, comorbidity, and healthcare utilization. RESULTS Among 32,965 patients, 45.1% received screening. In adjusted models, residential mobility, residence type, and neighborhood majority race were associated with colorectal cancer screening. Nearly all measures of patient-level social disadvantage and healthcare utilization were significant. CONCLUSIONS Address-based linkage of EHRs to external datasets may have the potential to expand meaningful measurement of multilevel social disadvantage. Researchers should strive to use granular, specific data in investigations of social disadvantage. IMPACT Generating multilevel measures of social disadvantage through address-based linkages efficiently uses existing EHR data for applied, population-level research.
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Affiliation(s)
- Amy E Hughes
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Epidemiology, Human Genetics, and Environmental Sciences UTHealth in Dallas, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Sandi L Pruitt
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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50
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Pruitt SL, Werner CL, Borton EK, Sanders JM, Balasubramanian BA, Barnes A, Betts AC, Skinner CS, Tiro JA. Cervical Cancer Burden and Opportunities for Prevention in a Safety-Net Healthcare System. Cancer Epidemiol Biomarkers Prev 2018; 27:1398-1406. [PMID: 30185535 DOI: 10.1158/1055-9965.epi-17-0912] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/29/2018] [Accepted: 08/30/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The high prevalence of cervical cancer at safety-net health systems requires careful analysis to best inform prevention and quality improvement efforts. We characterized cervical cancer burden and identified opportunities for prevention in a U.S. safety-net system. METHODS We reviewed tumor registry and electronic health record (EHR) data of women with invasive cervical cancer with ages 18+, diagnosed between 2010 and 2015, in a large, integrated urban safety-net. We developed an algorithm to: (i) classify whether women had been engaged in care (≥1 clinical encounter between 6 months and 5 years before cancer diagnosis); and (ii) identify missed opportunities (no screening, no follow-up, failure of a test to detect cancer, and treatment failure) and associated factors among engaged patients. RESULTS Of 419 women with cervical cancer, more than half (58%) were stage 2B or higher at diagnosis and 40% were uninsured. Most (69%) had no prior healthcare system contact; 47% were diagnosed elsewhere. Among 122 engaged in care prior to diagnosis, failure to screen was most common (63%), followed by lack of follow-up (21%), and failure of test to detect cancer (16%). Tumor stage, patient characteristics, and healthcare utilization differed across groups. CONCLUSIONS Safety-net healthcare systems face a high cervical cancer burden, mainly from women with no prior contact with the system. To prevent or detect cancer early, community-based efforts should encourage uninsured women to use safety-nets for primary care and preventive services. IMPACT Among engaged patients, strategies to increase screening and follow-up of abnormal screening tests could prevent over 80% of cervical cancer cases.
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Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas. .,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Claudia L Werner
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas.,Parkland Health and Hospital System, Dallas, Texas
| | - Eric K Borton
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Joanne M Sanders
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health in Dallas, Dallas, Texas
| | - Arti Barnes
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Andrea C Betts
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.,Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health in Dallas, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Jasmin A Tiro
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
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