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Graboyes EM, Cagle JL, Ramadan S, Prasad K, Yan F, Pearce J, Mazul AL, Anoma JS, Hill EG, Chera BS, Puram SV, Jackson R, Sandulache VC, Tam S, Topf MC, Kahmke R, Osazuwa-Peters N, Nussenbaum B, Alberg AJ, Sterba KR, Halbert CH. Neighborhood-Level Disadvantage and Delayed Adjuvant Therapy in Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024:2818081. [PMID: 38662392 PMCID: PMC11046410 DOI: 10.1001/jamaoto.2024.0424] [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: 11/01/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
Importance For patients with head and neck squamous cell carcinoma (HNSCC), initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is recommended by the National Comprehensive Cancer Network Guidelines and the Commission on Cancer. Although individual-level measures of socioeconomic status are associated with receipt of timely, guideline-adherent PORT, the role of neighborhood-level disadvantage has not been examined. Objective To characterize the association of neighborhood-level disadvantage with delays in receiving PORT. Design, Setting, and Participants This retrospective cohort study included 681 adult patients with HNSCC undergoing curative-intent surgery and PORT from 2018 to 2020 at 4 US academic medical centers. The data were analyzed between June 21, 2023, and March 5, 2024. Main Outcome Measures and Measures The primary outcome was delay in initiating guideline-adherent PORT (ie, >6 weeks after surgery). Time-to-PORT (TTP) was a secondary outcome. Census block-level Area Deprivation Index (ADI) scores were calculated and reported as national percentiles (0-100); higher scores indicate greater deprivation. The association of ADI scores with PORT delay was assessed using multivariable logistic regression adjusted for demographic, clinical, and institutional characteristics. PORT initiation across ADI score population quartiles was evaluated with cumulative incidence plots and Cox models. Results Among 681 patients with HNSCC undergoing surgery and PORT (mean [SD] age, 61.5 [11.2] years; 487 [71.5%] men, 194 [29.5%] women) the PORT delay rate was 60.8% (414/681) and median (IQR) TTP was 46 (40-56) days. The median (IQR) ADI score was 62.0 (44.0-83.0). Each 25-point increase in ADI score was associated with a corresponding 32% increase in the adjusted odds ratio (aOR) of PORT delay (aOR, 1.32; 95% CI, 1.07-1.63) on multivariable regression adjusted for institution, age, race and ethnicity, insurance, comorbidity, cancer subsite, stage, postoperative complications, care fragmentation, travel distance, and rurality. Increasing ADI score population quartiles were associated with increasing TTP (hazard ratio of PORT initiation, 0.71; 95% CI, 0.53-0.96; 0.59; 95% CI, 0.44-0.77; and 0.54; 95% CI, 0.41-0.72; for ADI quartiles 2, 3, and 4 vs ADI quartile 1, respectively). Conclusions and Relevance Increasing neighborhood-level disadvantage was independently associated with a greater likelihood of PORT delay and longer TTP in a dose-dependent manner. These findings indicate a critical need for the development of multilevel strategies to improve the equitable delivery of timely, guideline-adherent PORT.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Joshua Lee Cagle
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Salma Ramadan
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Kavita Prasad
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Flora Yan
- Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - John Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Angela L. Mazul
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jean-Sebastien Anoma
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Bhisham S. Chera
- Hollings Cancer Center, Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Sidharth V. Puram
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Ryan Jackson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Samantha Tam
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health, Detroit, Michigan
| | - Michael C. Topf
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Otolaryngology–Head & Neck Surgery
| | - Brian Nussenbaum
- American Board of Otolaryngology–Head and Neck Surgery, Houston, Texas
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia
| | - Katherine R. Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
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Duckett KA, Lee BJ, Chera BS, Puram SV, Sandulache VC, Kahmke R, Nguyen SA, Nussenbaum B, Alberg AJ, Halbert CH, Sterba KR, Graboyes EM. Author Reply to Letter by Topkan et al Regarding Delays in Starting Postoperative Radiotherapy. Otolaryngol Head Neck Surg 2024. [PMID: 38655738 DOI: 10.1002/ohn.769] [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: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Kelsey A Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Byung Joo Lee
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Advanced Specialty Sciences, James B. Edwards College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bhisham S Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Allen CG, Neil G, Halbert CH, Sterba KR, Nietert PJ, Welch B, Lenert L. Barriers and facilitators to the implementation of family cancer history collection tools in oncology clinical practices. J Am Med Inform Assoc 2024; 31:631-639. [PMID: 38164994 PMCID: PMC10873828 DOI: 10.1093/jamia/ocad243] [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: 05/16/2023] [Revised: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION This study aimed to identify barriers and facilitators to the implementation of family cancer history (FCH) collection tools in clinical practices and community settings by assessing clinicians' perceptions of implementing a chatbot interface to collect FCH information and provide personalized results to patients and providers. OBJECTIVES By identifying design and implementation features that facilitate tool adoption and integration into clinical workflows, this study can inform future FCH tool development and adoption in healthcare settings. MATERIALS AND METHODS Quantitative data were collected using survey to evaluate the implementation outcomes of acceptability, adoption, appropriateness, feasibility, and sustainability of the chatbot tool for collecting FCH. Semistructured interviews were conducted to gather qualitative data on respondents' experiences using the tool and recommendations for enhancements. RESULTS We completed data collection with 19 providers (n = 9, 47%), clinical staff (n = 5, 26%), administrators (n = 4, 21%), and other staff (n = 1, 5%) affiliated with the NCI Community Oncology Research Program. FCH was systematically collected using a wide range of tools at sites, with information being inserted into the patient's medical record. Participants found the chatbot tool to be highly acceptable, with the tool aligning with existing workflows, and were open to adopting the tool into their practice. DISCUSSION AND CONCLUSIONS We further the evidence base about the appropriateness of scripted chatbots to support FCH collection. Although the tool had strong support, the varying clinical workflows across clinic sites necessitate that future FCH tool development accommodates customizable implementation strategies. Implementation support is necessary to overcome technical and logistical barriers to enhance the uptake of FCH tools in clinical practices and community settings.
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Affiliation(s)
- Caitlin G Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Grace Neil
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Brandon Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Leslie Lenert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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Garrett E, Ma C, Ochoa-Dominguez CY, Navarro S, Yoon P, Hughes Halbert C, Farias AJ. Black cancer patients navigating a health-care system of racial discrimination. J Natl Cancer Inst 2024; 116:258-263. [PMID: 37849350 PMCID: PMC10852748 DOI: 10.1093/jnci/djad208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Exposure to racial discrimination may exacerbate disparities throughout the cancer care continuum. Therefore, we explored how experiences of racial discrimination in the health-care setting manifest for Black cancer patients and how it contributes to racial disparities in cancer care. METHODS This qualitative analysis used semistructured in-depth interviews with Black cancer survivors not on active treatment from May 2019 to March 2020. All interviews were audio recorded, professionally transcribed, and uploaded into Dedoose software for analysis. We identified major themes and subthemes that highlight exposure to racial discrimination and its consequences for Black cancer patients when receiving cancer care. RESULTS Participants included 18 Black cancer survivors, aged 29-88 years. Most patients experienced racial discrimination when seeking care. Participants experienced racial discrimination from their interactions with health-care staff, medical assistants, front desk staff, and health insurance administrators. Exposure to overt racial discrimination in the health-care setting was rooted in racial stereotypes and manifested through verbal insults such as physicians using phrases such as "you people." These experiences impacted the ability of the health-care delivery system to demonstrate trustworthiness. Patients noted "walking out" of their visit and not having their health issues addressed. Despite experiences with racial discrimination, patients still sought care out of necessity believing it was an inevitable part of the Black individual experience. CONCLUSION We identified that exposure to racial discrimination in the health-care setting is pervasive, affects health-seeking behaviors, and degrades the patient-clinician relationship, which may likely contribute to racial disparities in cancer care.
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Affiliation(s)
- Elleyse Garrett
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Cindy Ma
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Carol Y Ochoa-Dominguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Paul Yoon
- Keck School of Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Duckett KA, Kassir MF, Nguyen SA, Brennan EA, Chera BS, Sterba KR, Hughes Halbert C, Hill EG, McCay J, Puram SV, Sandulache VC, Kahmke R, Ramadan S, Nussenbaum B, Alberg AJ, Graboyes EM. Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:320-334. [PMID: 37731255 PMCID: PMC10840985 DOI: 10.1002/ohn.538] [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: 05/31/2023] [Revised: 08/10/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Initiating postoperative radiotherapy (PORT) within 6 weeks (42 days) of surgery is the first and only Commission on Cancer (CoC) approved quality metric for head and neck squamous cell carcinoma (HNSCC). No study has systematically reviewed nor synthesized the literature to establish national benchmarks for delays in starting PORT. DATA SOURCES Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a systematic review of PubMed, Scopus, and CINAHL. REVIEW METHODS Studies that described time-to-PORT or PORT delays in patients with HNSCC treated in the United States after 2003 were included. Meta-analysis of proportions and continuous measures was performed on nonoverlapping datasets to examine the pooled frequency of PORT delays and time-to-PORT. RESULTS Thirty-six studies were included in the systematic review and 14 in the meta-analysis. Most studies utilized single-institution (n = 17; 47.2%) or cancer registry (n = 16; 44.4%) data. Twenty-five studies (69.4%) defined PORT delay as >6 weeks after surgery (the definition utilized by the CoC and National Comprehensive Cancer Network Guidelines), whereas 4 (11.1%) defined PORT delay as a time interval other than >6 weeks, and 7 (19.4%) characterized time-to-PORT without defining delay. Meta-analysis revealed that 48.6% (95% confidence interval [CI], 41.4-55.9) of patients started PORT > 6 weeks after surgery. Median and mean time-to-PORT were 45.8 (95% CI, 42.4-51.4 days) and 47.4 days (95% CI, 43.4-51.4 days), respectively. CONCLUSION Delays in initiating guideline-adherent PORT occur in approximately half of patients with HNSCC. These meta-analytic data can be used to set national benchmarks and assess progress in reducing delays.
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Affiliation(s)
- Kelsey A Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohamed Faisal Kassir
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Bhishamjit S Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
- ENT Section, Operative CareLine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Salma Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Graboyes EM, Chappell M, Duckett KA, Sterba K, Halbert CH, Hill EG, Chera B, McCay J, Puram SV, Ramadan S, Sandulache VC, Kahmke R, Nussenbaum B, Alberg AJ, Paskett ED, Calhoun E. Patient Navigation for Timely, Guideline-Adherent Adjuvant Therapy for Head and Neck Cancer: A National Landscape Analysis. J Natl Compr Canc Netw 2023; 21:1251-1259.e5. [PMID: 38081134 PMCID: PMC10846494 DOI: 10.6004/jnccn.2023.7061] [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: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Aligned with the NCCN Clinical Practice Guidelines in Oncology for Head and Neck Cancers, in November 2021 the Commission on Cancer approved initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery for head and neck cancer (HNC) as its first and only HNC quality metric. Unfortunately, >50% of patients do not commence PORT within 6 weeks, and delays disproportionately burden racial and ethnic minority groups. Although patient navigation (PN) is a potential strategy to improve the delivery of timely, equitable, guideline-adherent PORT, the national landscape of PN for this aspect of care is unknown. MATERIALS AND METHODS From September through November 2022, we conducted a survey of health care organizations that participate in the American Cancer Society National Navigation Roundtable to understand the scope of PN for delivering timely, guideline-adherent PORT for patients with HNC. RESULTS Of the 94 institutions that completed the survey, 89.4% (n=84) reported that at least part of their practice was dedicated to navigating patients with HNC. Sixty-eight percent of the institutions who reported navigating patients with HNC along the continuum (56/83) reported helping them begin PORT. One-third of HNC navigators (32.5%; 27/83) reported tracking the metric for time-to-PORT at their facility. When estimating the timeframe in which the NCCN and Commission on Cancer guidelines recommend commencing PORT, 44.0% (37/84) of HNC navigators correctly stated ≤6 weeks; 71.4% (60/84) reported that they did not know the frequency of delays starting PORT among patients with HNC nationally, and 63.1% (53/84) did not know the frequency of delays at their institution. CONCLUSIONS In this national landscape survey, we identified that PN is already widely used in clinical practice to help patients with HNC start timely, guideline-adherent PORT. To enhance and scale PN within this area and improve the quality and equity of HNC care delivery, organizations could focus on providing better education and support for their navigators as well as specialization in HNC.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Chappell
- American Cancer Society National Navigation Roundtable, Cincinnati, Ohio
| | - Kelsey A. Duckett
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Elizabeth G. Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Bhishamjit Chera
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Sidharth V. Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Salma Ramadan
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Russel Kahmke
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Brian Nussenbaum
- American Board of Otolaryngology - Head and Neck Surgery, Houston, Texas
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Electra D. Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
- Division of Cancer Prevention Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Elizabeth Calhoun
- Department of Population Health, University of Illinois Chicago, Chicago, Illinois
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Halbert CH. Social Drivers of Cancer Risk and Outcomes Among African American Men. Cancer J 2023; 29:293-296. [PMID: 37963361 PMCID: PMC10914063 DOI: 10.1097/ppo.0000000000000681] [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: 11/16/2023]
Abstract
ABSTRACT Social risk factors play an important role in minority health and cancer health disparities. Exposure to stress and stress responses are important social factors that are now included in conceptual models of cancer health disparities. This report summarizes results from studies that examined stress exposure and responses among African Americans. Data from studies that were conducted as part of a transdisciplinary and translational research center are also presented to provide additional insight about the nature of racial differences in specific stressors among African American and White prostate cancer patients.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles CA 90089
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089
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Allen CG, Jefferson M, Magwood G, Melvin C, Babatunde OA, Halbert CH. Understanding men's beliefs and concerns about linking health data in the context of precision medicine. J Clin Transl Sci 2023; 7:e150. [PMID: 37456269 PMCID: PMC10346034 DOI: 10.1017/cts.2023.573] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 05/01/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Background/Objective Linking data is a critical feature of precision medicine initiatives that involves integrating information from multiple sources to improve researchers' and clinicians' ability to deliver care. We have limited understanding of how individuals perceive linking data as it relates to precision medicine. The aim of this study was to identify how sociodemographics, comorbidities, and beliefs about precision medicine influence two outcomes related to linking data: beliefs about linking data and concerns about linking data among men. Methods We recruited 124 adult men from primary care practices at a large clinical research university to complete a cross-sectional survey that included questions about sociodemographic characteristics, comorbidities, beliefs, benefits, and limitations of precision medicine, and two outcomes of interest: beliefs about the value of linking data and concerns about linking data. Descriptive statistics, bivariate associations, and multivariable regression were conducted. Results Participants had positive beliefs about linking data for precision medicine (M = 4.05/5) and average concern about linking data (M = 2.1/5). Final multivariable models revealed that higher levels of loneliness are associated with more positive beliefs about linking data (β = 0.41, p = 0.027). Races other than African American (β = -0.64, p = 0.009) and those with lower perceived limitations of precision medicine were less likely to be concerned about linking data (β = -0.75, p = 0.0006). Conclusion Our results advance the literature about perceptions of linking data for use in clinical and research studies among men. Better understanding of factors associated with more positive perceptions of data linkages could help improve how researchers recruit and engage participants.
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Affiliation(s)
- Caitlin G. Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell Magwood
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Charleston, SC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Oluwole Adeyemi Babatunde
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Frey LJ, Hughes Halbert C, Blasy CD. Supporting the Capture of Social Needs Through Natural Language Processing. J Am Board Fam Med 2023; 36:513-514. [PMID: 37290826 PMCID: PMC10484332 DOI: 10.3122/jabfm.2022.220415r0] [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] [Indexed: 06/10/2023] Open
Abstract
Social factors impact morbidity and mortality among patients. Documenting social needs in the clinical notes is currently widely done by family physicians. The unstructured format of information on social factors in electronic health records limits the ability of providers to address these issues. A proposed solution is using natural language processing to identify social needs from the electronic health record. This could support physicians in capturing structured social needs information that is consistent and reproducible without increasing documentation burden.
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Affiliation(s)
- Lewis J Frey
- From the Ralph H. Johnson Veterans Affairs Medical Center (VAMC), Charleston, SC (LJF, CDB); University of Southern California, Los Angeles, CA (CHH)
| | - Chanita Hughes Halbert
- From the Ralph H. Johnson Veterans Affairs Medical Center (VAMC), Charleston, SC (LJF, CDB); University of Southern California, Los Angeles, CA (CHH)
| | - Christopher D Blasy
- From the Ralph H. Johnson Veterans Affairs Medical Center (VAMC), Charleston, SC (LJF, CDB); University of Southern California, Los Angeles, CA (CHH)
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10
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Siddappa M, Hussain S, Wani SA, White J, Tang H, Gray JS, Jafari H, Wu HC, Long MD, Elhussin I, Karanam B, Wang H, Morgan R, Hardiman G, Adelani IB, Rotimi SO, Murphy AR, Nonn L, Davis MB, Kittles RA, Hughes Halbert C, Sucheston-Campbell LE, Yates C, Campbell MJ. African American Prostate Cancer Displays Quantitatively Distinct Vitamin D Receptor Cistrome-transcriptome Relationships Regulated by BAZ1A. Cancer Res Commun 2023; 3:621-639. [PMID: 37082578 PMCID: PMC10112383 DOI: 10.1158/2767-9764.crc-22-0389] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/12/2023] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
African American (AA) prostate cancer associates with vitamin D3 deficiency, but vitamin D receptor (VDR) genomic actions have not been investigated in this context. We undertook VDR proteogenomic analyses in European American (EA) and AA prostate cell lines and four clinical cohorts. Rapid immunoprecipitation mass spectrometry of endogenous protein (RIME) analyses revealed that nonmalignant AA RC43N prostate cells displayed the greatest dynamic protein content in the VDR complex. Likewise, in AA cells, Assay for Transposase-Accessible Chromatin using sequencing established greater 1α,25(OH)2D3-regulated chromatin accessibility, chromatin immunoprecipitation sequencing revealed significant enhancer-enriched VDR cistrome, and RNA sequencing identified the largest 1α,25(OH)2D3-dependent transcriptome. These VDR functions were significantly corrupted in the isogenic AA RC43T prostate cancer cells, and significantly distinct from EA cell models. We identified reduced expression of the chromatin remodeler, BAZ1A, in three AA prostate cancer cohorts as well as RC43T compared with RC43N. Restored BAZ1A expression significantly increased 1α,25(OH)2D3-regulated VDR-dependent gene expression in RC43T, but not HPr1AR or LNCaP cells. The clinical impact of VDR cistrome-transcriptome relationships were tested in three different clinical prostate cancer cohorts. Strikingly, only in AA patients with prostate cancer, the genes bound by VDR and/or associated with 1α,25(OH)2D3-dependent open chromatin (i) predicted progression from high-grade prostatic intraepithelial neoplasia to prostate cancer; (ii) responded to vitamin D3 supplementation in prostate cancer tumors; (iii) differentially responded to 25(OH)D3 serum levels. Finally, partial correlation analyses established that BAZ1A and components of the VDR complex identified by RIME significantly strengthened the correlation between VDR and target genes in AA prostate cancer only. Therefore, VDR transcriptional control is most potent in AA prostate cells and distorted through a BAZ1A-dependent control of VDR function. Significance Our study identified that genomic ancestry drives the VDR complex composition, genomic distribution, and transcriptional function, and is disrupted by BAZ1A and illustrates a novel driver for AA prostate cancer.
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Affiliation(s)
- Manjunath Siddappa
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Shahid Hussain
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Sajad A. Wani
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Jason White
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama
| | - Hancong Tang
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Jaimie S. Gray
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Hedieh Jafari
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Hsu-Chang Wu
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Mark D. Long
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Isra Elhussin
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama
| | - Balasubramanyam Karanam
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama
| | - Honghe Wang
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama
| | - Rebecca Morgan
- School of Biological Sciences, Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom
| | - Gary Hardiman
- School of Biological Sciences, Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - Solomon O. Rotimi
- Department of Biochemistry, Covenant University, Ota, Ogun State, Nigeria
| | - Adam R. Murphy
- Department of Urology, Northwestern Medicine, Chicago, Illinois
| | - Larisa Nonn
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Melissa B. Davis
- Department of Surgery, Weill Cornell Medicine, New York City, New York
| | - Rick A. Kittles
- Division of Health Equities, Department of Population Sciences, City of Hope, Duarte, California
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Lara E. Sucheston-Campbell
- Division of Pharmacy Practice and Science, College of Pharmacy, The Ohio State University, Columbus, Ohio
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Clayton Yates
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Oncology Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Moray J. Campbell
- Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, The Ohio State University, Columbus, Ohio
- Corresponding Author: Moray J. Campbell, Cedars-Sinai Medical Center, Los Angeles, CA 90048. Phone: (424) 314-0367; E-mail:
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11
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Reams RR, Odedina FT, Carpten JD, Redda K, Stern MC, Krieger JL, Aparicio J, Hensel B, Askins N, Abreu A, Adams A, Agyare E, Ali J, Allen JM, Aló R, Baezconde-Garbanati L, Brant J, Brown CP, Buxbaum SG, Cohen P, Cozen W, Ezenwa MO, Falzarano S, Fillingim RB, Flores-Rozas H, Fredenburg KM, George T, Han B, Huang Y, Hughes Halbert C, Kiros GE, Lamango NS, Lee JH, Lyon DE, Mitchell DA, Mochona B, Nieva JJ, Offringa IA, Okunieff P, Parker A, Rhie SK, Richey JM, Rogers SC, Salhia B, Schmittgen TD, Segal R, Setiawan VW, Smith U, Su LM, Suther S, Trevino J, Velazquez-Villarreal EI, Webb FJ, Wu AH, Yao Y, Wilkie DJ. Florida-California Cancer Research, Education and Engagement (CaRE 2) Health Equity Center: Structure, Innovations, and Initial Outcomes. Cancer Control 2023; 30:10732748231197878. [PMID: 37703814 PMCID: PMC10501072 DOI: 10.1177/10732748231197878] [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: 05/22/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION The Florida-California Cancer Research, Education, and Engagement (CaRE2) Health Equity Center is a triad partnership committed to increasing institutional capacity for cancer disparity research, the diversity of the cancer workforce, and community empowerment. This article provides an overview of the structure, process innovations, and initial outcomes from the first 4 years of the CaRE2 triad partnership. METHODS CaRE2 serves diverse populations in Florida and California using a "molecule to the community and back" model. We prioritize research on the complex intersection of biological, environmental, and social determinants health, working together with scientific and health disparities communities, sharing expertise across institutions, bidirectional training, and community outreach. Partnership progress and outcomes were assessed using mixed methods and four Program Steering Committee meetings. RESULTS Research capacity was increased through development of a Living Repository of 81 cancer model systems from minority patients for novel cancer drug development. CaRE2 funded 15 scientific projects resulting in 38 publications. Workforce diversity entailed supporting 94 cancer trainees (92 URM) and 34 ESIs (32 URM) who coauthored 313 CaRE2-related publications and received 48 grants. Community empowerment was promoted via outreaching to more than 3000 individuals, training 145 community cancer advocates (including 28 Community Scientist Advocates), and publishing 10 community reports. CaRE2 members and trainees together have published 639 articles, received 61 grants, and 57 awards. CONCLUSION The CaRE2 partnership has achieved its initial aims. Infrastructure for translational cancer research was expanded at one partner institution, and cancer disparities research was expanded at the two cancer centers.
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Affiliation(s)
- R. Renee Reams
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | | | - John D. Carpten
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Kinfe Redda
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Mariana C. Stern
- Departments of Population and Public Health Sciences, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Janice L. Krieger
- Department of Advertising, University of Florida, Gainesville, FL, USA
| | - Jose Aparicio
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Brooke Hensel
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Nissa Askins
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Andre Abreu
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Angela Adams
- Department of Pharmaceutics, University of Florida, Gainesville, FL, USA
| | - Edward Agyare
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Jamel Ali
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
- Department of Chemical and Biomedical Engineering, Florida State University, Tallahassee, FL, USA
| | - John M. Allen
- Department of Pharmacotherapy & Translational Research, University of Florida, Orlando, FL, USA
| | - Richard Aló
- College of Science and Technology, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Lourdes Baezconde-Garbanati
- Departments of Population and Public Health Sciences, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason Brant
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Clyde P. Brown
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Sarah G. Buxbaum
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Pinchas Cohen
- University of Southern California Leonard Davis School of Gerontology, Los Angeles, CA, USA
| | - Wendy Cozen
- Division of Hematology/Oncology, School of Medicine, University of California, Irvine, CA, USA
| | - Miriam O. Ezenwa
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Sara Falzarano
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Hernan Flores-Rozas
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Kristianna M. Fredenburg
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas George
- Department of Medicine in the College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bo Han
- Departments of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Yong Huang
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | - Chanita Hughes Halbert
- Departments of Population and Public Health Sciences, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Gebre-Egziabher Kiros
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Nazarius S. Lamango
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Debra E. Lyon
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Duane A. Mitchell
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Bereket Mochona
- Department of Chemistry, Florida Agricultural and Mechanical University, Tallahassee, FL USA
| | - Jorge J. Nieva
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ite A. Offringa
- Departments of Surgery, University of Southern California, Los Angeles, CA, USA
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, CA, USA
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Alexander Parker
- College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Suhn K. Rhie
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joyce M. Richey
- Department of Clinical Physiology and Neuroscience, University of Southern California, Los Angeles, CA, USA
| | - Sherise C. Rogers
- Department of Medicine in the College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bodour Salhia
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | | | - Richard Segal
- Department of Pharmaceutical Outcome and Policy, University of Florida, Gainesville, FL, USA
| | | | - Ukamaka Smith
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Li-Ming Su
- Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sandra Suther
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Jose Trevino
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Fern J. Webb
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Anna H. Wu
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Yingwei Yao
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Diana J. Wilkie
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
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12
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Hughes Halbert C. Social Determinants of Health and Cancer Care: Where Do We Go From Here? J Natl Cancer Inst 2022; 114:1564-1566. [PMID: 36073955 PMCID: PMC9745423 DOI: 10.1093/jnci/djac175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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13
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Raber M, Jackson A, Basen-Engquist K, Bradley C, Chambers S, Gany FM, Halbert CH, Lindau ST, Pérez-Escamilla R, Seligman H. Food Insecurity Among People With Cancer: Nutritional Needs as an Essential Component of Care. J Natl Cancer Inst 2022; 114:1577-1583. [PMID: 36130287 PMCID: PMC9745434 DOI: 10.1093/jnci/djac135] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 01/14/2023] Open
Abstract
A cancer diagnosis can upend work and family life, leading patients to reallocate resources away from essentials such as food. Estimates of the percentage of people navigating a cancer diagnosis and food insecurity range between 17% and 55% of the cancer patient population. The complexity of addressing food insecurity among those diagnosed with cancer during different phases of treatment is multifactorial and often requires an extensive network of support throughout each phase. This commentary explores the issue of food insecurity in the context of cancer care, explores current mitigation efforts, and offers a call to action to create a path for food insecurity mitigation in the context of cancer. Three programs that address food insecurity among those with cancer at various stages of care are highlighted, drawing attention to current impact and actionable recommendations to make programs like these scalable and sustainable. Recommendations are grounded in the National Academies of Sciences, Engineering, and Medicine social care framework through 5 essential domain areas: awareness, adjustment, assistance, alignment, and advocacy. This commentary seeks to highlight opportunities for the optimization of cancer care and reframe food access as an essential part of treatment and long-term care plans.
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Affiliation(s)
- Margaret Raber
- Department of Pediatrics, US Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Ann Jackson
- Center for Food Equity in Medicine, Flossmoor, IL, USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cathy Bradley
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | | | - Francesca M Gany
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Stacy Tessler Lindau
- Departments of Ob/Gyn and Medicine-Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Hilary Seligman
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Epidemiology, University of California, San Francisco, CA, USA
- Department of Biostatistics, University of California, San Francisco, CA, USA
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14
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Espinoza-Gutarra MR, Duma N, Aristizabal P, Segarra-Vazquez B, Borno H, Halbert CH, Simon MA, Velazquez AI. The Problem of Hispanic/Latinx Under-Representation in Cancer Clinical Trials. JCO Oncol Pract 2022; 18:380-384. [PMID: 35544652 DOI: 10.1200/op.22.00214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Narjust Duma
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Paula Aristizabal
- University of California San Diego, Department of Pediatrics, Division of Pediatric Hematology/Oncology, San Diego, CA.,Rady Children's Hospital San Diego, Peckham Center for Cancer and Blood Disorders, San Diego, CA.,University of California San Diego Moores Cancer Center, Population Sciences Disparities and Community Engagement, San Diego, CA
| | | | - Hala Borno
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | - Melissa A Simon
- Northwestern University, Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
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15
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Abstract
Since the completion of the Human Genome Project, considerable progress has been made in translating knowledge about the genetic basis of disease risk and treatment response into clinical services and public health interventions that have greater precision. It is anticipated that more precision approaches to early detection, prevention, and treatment will be developed and will enhance equity in healthcare and outcomes among disparity populations. Reduced access to genomic medicine research, clinical services, and public health interventions has the potential to exacerbate disparities in genomic medicine. The purpose of this article is to describe these challenges to equity in genomic medicine and identify opportunities and future directions for addressing these issues. Efforts are needed to enhance access to genomic medicine research, clinical services, and public health interventions, and additional research that examines the clinical utility of precision medicine among disparity populations should be prioritized to ensure equity in genomic medicine. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA; .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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16
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Vogel EA, Barrington-Trimis JL, Kechter A, Tackett AP, Liu F, Sussman S, Lerman C, Unger JB, Hughes Halbert C, Chaffee BW, Leventhal AM. Differences in Young Adults' Perceptions of and Willingness to Use Nicotine Pouches by Tobacco Use Status. Int J Environ Res Public Health 2022; 19:ijerph19052685. [PMID: 35270385 PMCID: PMC8910652 DOI: 10.3390/ijerph19052685] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 01/27/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 01/27/2023]
Abstract
Oral nicotine pouches may appeal to young adult current nicotine/tobacco users interested in alternative forms of nicotine that lack pulmonary exposure, but may also appeal to young adult non-users of nicotine/tobacco products. We used data from a 2020 remote digital survey of an ongoing cohort study of young adults from Southern California (aged 19-23) to examine differences in pouch perceptions and use willingness across nicotine/tobacco use statuses. Participants who had never used nicotine pouches (N = 1167) viewed text/imagery from mass-marketed pouch packaging and advertising, then completed measures of willingness to use nicotine pouches, pouch harm perceptions, and hypothetical choice of cigarettes or e-cigarettes over pouches. Willingness to use pouches was significantly higher among non-combustible only (33.8%), combustible only (29.3%), and dual (43.9%) users than non-users (14.7%). Overall, 49.1% of participants were uncertain whether pouches were less harmful than cigarettes and 52.4% were uncertain whether pouches were less harmful than e-cigarettes. Relative harm perceptions did not significantly differ by tobacco use status. Those using non-combustible products (either alone or as part of dual use with combustible tobacco) had greater odds than non-users of reporting that they would use e-cigarettes over nicotine pouches. By contrast, all tobacco product user groups reported greater odds than non-users that they would use cigarettes over pouches. In sum, a sizable minority of young adults might be willing to try using nicotine pouches, but most are uncertain about the relative harm of pouches.
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Affiliation(s)
- Erin A. Vogel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
- Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA;
- Correspondence:
| | - Jessica L. Barrington-Trimis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
- Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA;
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Afton Kechter
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
- Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA;
| | - Alayna P. Tackett
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
- Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA;
| | - Fei Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
- Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA;
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Caryn Lerman
- Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA;
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
- Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA;
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Benjamin W. Chaffee
- Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California, San Francisco, CA 94118, USA;
| | - Adam M. Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (J.L.B.-T.); (A.K.); (A.P.T.); (F.L.); (S.S.); (J.B.U.); (C.H.H.); (A.M.L.)
- Institute for Addiction Science, University of Southern California, Los Angeles, CA 90089, USA;
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
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17
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Babatunde OA, Eberth JM, Felder TM, Moran R, Halbert CH, Truman S, Hebert JR, Heiney S, Adams SA. Racial Disparities and Diagnosis-to-Treatment Time Among Patients Diagnosed with Breast Cancer in South Carolina. J Racial Ethn Health Disparities 2022; 9:124-134. [PMID: 33428159 PMCID: PMC8272729 DOI: 10.1007/s40615-020-00935-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 09/29/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Diagnosis-to-treatment interval is an important quality measure that is recognized by the National Accreditation Program for Breast Centers, and the American Society of Breast Surgeons and the National Quality Measures for Breast Care. The aim of this study was to assess factors related to delays in receiving breast cancer treatment. METHODS This retrospective cohort study (2002 to 2010) used data from the South Carolina Central Cancer Registry (SCCCR) and Office of Revenue and Fiscal Affairs (RFA) to examine racial differences in diagnosis-to-treatment time (in days), with adjuvant hormone receipt, surgery, chemotherapy, and radiotherapy assessed separately. Chi-square tests, and logistic regression and generalized linear models were used to compare diagnosis-to-treatment days. RESULTS Black women on average received adjuvant hormone therapy, surgery, chemotherapy, and radiotherapy 25, 8, 7, and 3 days later than their White counterparts, respectively. Black women with local stage cancer had later time to surgery (OR: 1.6; CI: 1.2-2.2) compared with White women with local stage cancer. Black women living in rural areas had higher odds (OR: 2.0; CI: 1.1-3.7) of receiving late chemotherapy compared with White women living in rural areas. Unmarried Black women also had greater risk (OR: 2.0; CI: 1.0-4.0) of receiving late radiotherapy compared to married White women. CONCLUSIONS To improve timely receipt of effective BrCA treatments, programs aimed at reducing racial disparities may need to target subgroups of Black breast cancer patients based on their social determinants of health and geographic residence.
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Affiliation(s)
- Oluwole A. Babatunde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208
| | - Jan M. Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208
| | - Tisha M. Felder
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208
| | - Robert Moran
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Samantha Truman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208
| | - James R. Hebert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208.,College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208.,Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201
| | - Sue Heiney
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, University of South Carolina, Columbia, SC, 29208.,College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208
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18
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Ritchie JB, Welch BM, Allen CG, Frey LJ, Morrison H, Schiffman JD, Alekseyenko AV, Dean B, Hughes Halbert C, Bellcross C. Comparison of a Cancer Family History Collection and Risk Assessment Tool - ItRunsInMyFamily - with Risk Assessment by Health-Care Professionals. Public Health Genomics 2021; 25:1-9. [PMID: 34872100 PMCID: PMC9167897 DOI: 10.1159/000520001] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Primary care providers (PCPs) and oncologists lack time and training to appropriately identify patients at increased risk for hereditary cancer using family health history (FHx) and clinical practice guideline (CPG) criteria. We built a tool, "ItRunsInMyFamily" (ItRuns) that automates FHx collection and risk assessment using CPGs. The purpose of this study was to evaluate ItRuns by measuring the level of concordance in referral patterns for genetic counseling/testing (GC/GT) between the CPGs as applied by the tool and genetic counselors (GCs), in comparison to oncologists and PCPs. The extent to which non-GCs are discordant with CPGs is a gap that health information technology, such as ItRuns, can help close to facilitate the identification of individuals at risk for hereditary cancer. METHODS We curated 18 FHx cases and surveyed GCs and non-GCs (oncologists and PCPs) to assess concordance with ItRuns CPG criteria for referring patients for GC/GT. Percent agreement was used to describe concordance, and logistic regression to compare providers and the tool's concordance with CPG criteria. RESULTS GCs had the best overall concordance with the CPGs used in ItRuns at 82.2%, followed by oncologists with 66.0% and PCPs with 60.6%. GCs were significantly more likely to concur with CPGs (OR = 4.04, 95% CI = 3.35-4.89) than non-GCs. All providers had higher concordance with CPGs for FHx cases that met the criteria for genetic counseling/testing than for cases that did not. DISCUSSION/CONCLUSION The risk assessment provided by ItRuns was highly concordant with that of GC's, particularly for at-risk individuals. The use of such technology-based tools improves efficiency and can lead to greater numbers of at-risk individuals accessing genetic counseling, testing, and mutation-based interventions to improve health.
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Affiliation(s)
- Jordon B. Ritchie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
| | - Brandon M. Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC US
| | - Caitlin G. Allen
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Rollins School of Public Health, Atlanta, Georgia, U.S
| | - Lewis J. Frey
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
| | - Heath Morrison
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
| | - Joshua D. Schiffman
- Oncological Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, U.S
| | | | - Brian Dean
- Computer Science, Clemson University, Clemson, SC, U.S
| | - Chanita Hughes Halbert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC US
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC US
| | - Cecelia Bellcross
- Department of Human Genetics, Emory University, Atlanta, Georgia, U.S
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Abstract
Achieving health equity among disparity populations has been a national, regional, and local priority for several years. Health promotion and disease prevention behaviors play an important role in achieving health equity; the first generation of behavioral science studies in minority health and health disparities have provided important insights about the nature and distribution of risk exposure behaviors in disparity populations. Interventions have also been developed to enhance health promotion and disease prevention behaviors using behavioral counseling, tailored health communications, and interventions that are developed collaboratively with community stakeholders. Although intervention development and evaluation are components of transdisciplinary translational behavior research, discovery science is a critical first step in translational research. Consistent with this, conceptual models and frameworks of minority health and health disparities have evolved to include multilevel determinants that include basic behavioral mechanisms such as stress responses and stress reactivity that have physiological, psychological, and behavioral components that are relevant to minority health and health disparities. This report describes priorities, opportunities, and barriers to conducting transdisciplinary translational behavioral research during the next generation of minority health and health disparities research.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Caitlin G Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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20
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Babatunde OA, Zahnd WE, Eberth JM, Lawson AB, Adams SA, Boakye EA, Jefferson MS, Allen CG, Pearce JL, Li H, Halbert CH. Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina. Int J Environ Res Public Health 2021; 18:ijerph182211824. [PMID: 34831579 PMCID: PMC8625868 DOI: 10.3390/ijerph182211824] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions-the social deprivation index (SDI). Data were analyzed using chi-square tests, Student's t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02-1.10), African American race (OR = 1.35, 95% CI: 1.29-1.41), and being unmarried (OR = 1.17, 95% CI: 1.13-1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
- Department of Psychiatry, Prisma Health, 109 Physicians Drive, Greer, SC 29650, USA
- Correspondence: ; Tel.: +1-803-477-1675
| | - Whitney E. Zahnd
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA; (W.E.Z.); (J.M.E.)
| | - Jan M. Eberth
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA; (W.E.Z.); (J.M.E.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Cancer Survivorship Center, College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL 62794, USA;
| | - Melanie S. Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
| | - Caitlin G. Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
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21
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Halbert CH, Jefferson M, Allen CG, Babatunde OA, Drake R, Angel P, Savage SJ, Frey L, Lilly M, Obi T, Obeid J. Racial Differences in Patient Portal Activation and Research Enrollment Among Patients With Prostate Cancer. JCO Clin Cancer Inform 2021; 5:768-774. [PMID: 34328797 PMCID: PMC8812608 DOI: 10.1200/cci.20.00131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The purpose of this study was to examine racial differences in patient portal activation and research participation among patients with prostate cancer. MATERIALS AND METHODS Participants were African American and White patients with prostate cancer who were treated with radical prostatectomy (n = 218). Patient portal activation was determined using electronic health records, and research participation was measured based on completion of a social determinants survey. RESULTS Thirty-one percent of patients completed the social determinants survey and enrolled in the study and 66% activated a patient portal. The likelihood of enrolling in the study was reduced with greater levels of social deprivation (odds ratio [OR], 0.70; 95% CI, 0.50 to 0.98; P = .04). Social deprivation also had a signification independent association with patient portal activation along with racial background. African American patients (OR, 0.48; 95% CI, 0.23 to 0.91; P = .02) and those with greater social deprivation (OR, 0.58; 95% CI, 0.42 to 0.82; P = .002) had a lower likelihood of activating a patient portal compared with White patients and those with lower social deprivation. CONCLUSION Although the majority of patients with prostate cancer activated their patient portal, rates of patient portal activation were lower among African American patients and those who lived in areas with greater social deprivation. Greater efforts are needed to promote patient portal activation among African American patients with prostate cancer and address access to health information technology among those who live in socially disadvantaged geographic areas.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Caitlin G Allen
- Department of Behavioral Sciences and Health Education; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Oluwole A Babatunde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Richard Drake
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Peggi Angel
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Stephen J Savage
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Lewis Frey
- Department of Public Health Sciences, Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC
| | - Michael Lilly
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Division of Hematology-Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Ted Obi
- Ichan School of Medicine at Mount Sinai, New York, NY
| | - Jihad Obeid
- Department of Public Health Sciences, Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC
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Graboyes EM, Halbert CH, Li H, Warren GW, Alberg AJ, Calhoun EA, Nussenbaum B, Marsh CH, McCay J, Day TA, Kaczmar JM, Sharma AK, Neskey DM, Sterba KR. Barriers to the Delivery of Timely, Guideline-Adherent Adjuvant Therapy Among Patients With Head and Neck Cancer. JCO Oncol Pract 2020; 16:e1417-e1432. [PMID: 32853120 PMCID: PMC7735037 DOI: 10.1200/op.20.00271] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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] [Accepted: 07/17/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival. However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown. This study aims to identify the multilevel barriers to timely, guideline-adherent PORT and organize them into a conceptual model. MATERIALS AND METHODS Semi-structured interviews with key informants were conducted with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45). Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model. RESULTS In all, 27 patients with HNSCC undergoing surgery and PORT were included, of whom 41% were African American, and 37% had surgery and PORT at different facilities. Eighteen clinicians representing a diverse mix of provider types from 7 oncology practices participated in key informant interviews. Five key themes representing barriers to timely PORT were identified across 5 health care delivery levels: (1) inadequate education about timely PORT, (2) postsurgical sequelae that interrupt the tight treatment timeline (both intrapersonal level), (3) insufficient coordination and communication during care transitions (interpersonal and health care team levels), (4) fragmentation of care across health care organizations (organizational level), and (5) travel burden for socioeconomically disadvantaged patients (community level). CONCLUSION This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Chanita Hughes Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Graham W. Warren
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Elizabeth A. Calhoun
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, AZ
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, TX
| | - Courtney H. Marsh
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Terry A. Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - John M. Kaczmar
- Department of Medicine, Division of Medical Oncology, Medical University of South Carolina, Charleston, SC
| | - Anand K. Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - David M. Neskey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Katherine R. Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Jefferson M, Magwood G, Melvin C, Babatunde O, Halbert CH, Allen CG. Abstract PO-074: Understanding men’s concerns about linking health data in the context of precision medicine. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-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
Background and Importance: Linking data is a critical feature of precision medicine initiatives that involves integrating information from multiple sources to improve researchers’ and clinicians’ ability to deliver care. To date, we have limited understanding of how racial and ethnic minorities perceive linking data as it relates to precision medicine. Objective: The aim of this study was to identify how demographics, co-morbidities, and beliefs about precision medicine influence two outcomes related to linking data: beliefs about linking data and concerns about linking data among minority men. Methods: Adult individuals were recruited from primary care practices at a large clinical research university. 375 individuals were invited to participate and 124 completed a cross-sectional survey that included questions about demographic characteristics, comorbidities, beliefs, benefits, and limitations of precision medicine, and two outcomes of interest: beliefs about the value of linking data and concerns about linking data. Descriptives, bivariate, and multivariable regression were conducted in SAS version 9.4. Results: Participants had positive perceptions about beliefs about linking data for precision medicine (M=4.05/5) and average concern about linking data (M=2.1/5). Final multivariable models revealed that higher levels of loneliness are associated with more positive beliefs about linking data (B=0.41, p=0.027). Races other than Black or African American (B=-0.64, p=0.009) and those with lower perceived limitations of precision medicine were less likely to be concerned about linking data (B=-0.75, p=-.0006).
Conclusion and Relevance: Our results contribute to the lack of literature about perceptions of linking data for use in clinical and research studies among men. Better understanding of factors associated with more positive perceptions of data linkages could help improve how researchers recruit and engage participants.
Citation Format: Melanie Jefferson, Gayenell Magwood, Cathy Melvin, Oluwole Babatunde, Chanita Hughes Halbert, Caitlin G. Allen. Understanding men’s concerns about linking health data in the context of precision medicine [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-074.
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Affiliation(s)
| | | | - Cathy Melvin
- 1Medical University of South Carolina, Charleston, SC,
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Graboyes EM, Sterba KR, Li H, Warren G, Alberg AJ, Calhoun EA, Nussenbaum B, McCay J, Marsh CH, Neskey DM, Kaczmar J, Sharma AK, Harper J, Day TA, Halbert CH. Abstract PO-231: Development and evaluation of a theory-based, multilevel intervention to improve the delivery of timely, guideline-adherent adjuvant therapy for patients with head and neck cancer. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-231] [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
Background: Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) occur in more than 50% of patients and are key drivers of excess mortality and racial disparities in survival. Theory-based multilevel interventions to address delays and racial disparities in timely PORT have not been described and effective interventions to improve timely, equitable PORT are lacking. Purpose: This study aims to describe the development of NDURE (Navigation for Disparities and Untimely Radiation Therapy), a novel theory- based, multilevel intervention to decrease delays starting PORT and evaluate its feasibility, acceptability, and preliminary clinical efficacy. Methods: An intervention mapping approach was used to develop NDURE. Consecutive patients with locally- advanced HNSCC undergoing surgery and PORT were enrolled into a single-arm clinical trial. Results: NDURE targets the determinants of timely, guideline-adherent PORT through the following core functions: 1) patient education, 2) standardization of the process for initiating the discussion of PORT, 3) PORT care plans, 4) provider role definition, 5) referral tracking and follow-up, and 6) transportation assistance.
NDURE was feasible, as judged by trial accrual (88% overall; 100% for African Americans) and dropout (n=0). 100% of patients reported moderate/strong agreement that NDURE helped solve challenges starting PORT; 86% were highly likely to recommend NDURE. The rate of timely, guideline-adherent PORT was 86% overall and 100% for African Americans. Conclusions: NDURE is a novel, theory-based, multilevel intervention targeting determinants of timely PORT among HNSCC patients. NDURE is feasible, acceptable, and has potential to improve the timely, equitable, guideline-adherent PORT. These results support conducting a randomized controlled trial to test NDURE’s clinical efficacy. clinicaltrials.gov number NCT04030130
Citation Format: Evan M. Graboyes, Katherine R. Sterba, Hong Li, Graham Warren, Anthony J. Alberg, Elizabeth A. Calhoun, Brian Nussenbaum, Jessica McCay, Courtney H. Marsh, David M. Neskey, John Kaczmar, Anand K. Sharma, Jennifer Harper, Terry A. Day, Chanita Hughes Halbert. Development and evaluation of a theory-based, multilevel intervention to improve the delivery of timely, guideline-adherent adjuvant therapy for patients with head and neck cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-231.
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Affiliation(s)
| | | | - Hong Li
- 1Medical University of South Carolina, Charleston, SC,
| | - Graham Warren
- 1Medical University of South Carolina, Charleston, SC,
| | | | | | - Brian Nussenbaum
- 4American Board of Otolaryngology-Head & Neck Surgery, Houston, TX
| | - Jessica McCay
- 1Medical University of South Carolina, Charleston, SC,
| | | | | | - John Kaczmar
- 1Medical University of South Carolina, Charleston, SC,
| | | | | | - Terry A. Day
- 1Medical University of South Carolina, Charleston, SC,
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Halbert CH, Allen CG, Jefferson M, Magwood GS, Melvin C, Babatunde OA, Baquet C, Delmoor E, Johnson J, Mathews D, Leach RJ, Ricks-Santi L. Lessons Learned from the Medical University of South Carolina Transdisciplinary Collaborative Center (TCC) in Precision Medicine and Minority Men's Health. Am J Mens Health 2020; 14:1557988320979236. [PMID: 33319609 PMCID: PMC7745579 DOI: 10.1177/1557988320979236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Abstract
The Transdisciplinary Collaborative Center (TCC) in Precision Medicine for Minority Men's Health was established at the Medical University of South Carolina (MUSC) in 2015 to address disparities in the translation of precision medicine approaches among racial minority groups. This regional consortium focuses on three primary areas: (1) the development of a consortium of regional and national partners, (2) conducting transdisciplinary research examining synergistic effects of biological, social, physiological, and clinical determinants of chronic disease risks and outcomes, and (3) dissemination and implementation of precision medicine approaches, with an emphasis on reducing disparities in health care and outcomes among minority men. Given consistent calls to better translate precision medicine approaches and the focus of this consortium on addressing disparities among minority men, we provide an overview of our experience in developing the MUSC TCC, including barriers and facilitators to conducting translational research on minority men's health issues in the context of precision medicine. Lessons learned and areas for improvement include providing enough time to create consistent partnerships and community engagement to improve recruitment and retention, identifying unique ways to engage diverse partners from across the region and nation, and better approaches to dissemination and communication for large partnerships focusing on precision medicine.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlin G. Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell S. Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Oluwole Adeyami Babatunde
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Claudia Baquet
- Hope Institute LLC and UMB School of Pharmacy Pharmaceutical HSR, Baltimore, USA
| | - Ernestine Delmoor
- Philadelphia Chapter, National Black Leadership Initiative on Cancer, Philadelphia, PA, USA
| | - Jerry Johnson
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Robin J. Leach
- Department of Cell Systems and Anatomy, Mays Cancer Center, UT Health San Antonio, San Antonio, TX, USA
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Bauer AG, Jefferson M, Nahhas GJ, Savage S, Drake R, Lilly M, Ambrose L, Caulder S, Mahvi D, Hughes Halbert C. Financial toxicity and strain among men receiving prostate cancer care in an equal access healthcare system. Cancer Med 2020; 9:8765-8771. [PMID: 33070458 PMCID: PMC7724486 DOI: 10.1002/cam4.3484] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To examine financial toxicity and strain among men in an equal access healthcare system based on social determinants and clinical characteristics. Methods Observational study among men receiving prostate cancer care (n = 49) at a Veterans Health Administration (VHA) facility. Financial hardship included overall financial strain and financial toxicity due to healthcare costs. Financial strain was measured with one item asking how much money they have leftover at the end of the month. Financial toxicity was measured with the Comprehensive Score for Financial Toxicity (COST) scale. Results Comprehensive Score for Financial Toxicity scores among participants indicated moderate levels of financial toxicity (M = 24.4, SD = 9.9). For financial strain, 36% of participants reported that they did not have enough money left over at the end of the month. There were no racial or clinically related differences in financial toxicity, but race and income level had significant associations with financial strain. Conclusion Financial toxicity and strain should be measured among patients in an equal access healthcare system. Findings suggest that social determinants may be important to assess, to identify patients who may be most likely to experience financial hardship in the context of obtaining cancer care and implement efforts to mitigate the burden for those patients.
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Affiliation(s)
- Alexandria G Bauer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Savage
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Urology, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - Richard Drake
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Michael Lilly
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Linda Ambrose
- Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - Susan Caulder
- Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - David Mahvi
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Allen CG, Ritchie JB, Morrison H, Lauzon SD, Nichols M, Schiffman JD, Hughes Halbert C, Welch BM. A thematic analysis of health information technology use among cancer genetic counselors. J Genet Couns 2020; 30:170-179. [PMID: 32643297 DOI: 10.1002/jgc4.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
As precision medicine becomes a mainstay in health care, the use of health information technology (IT) platforms will play an important role in the delivery of services across the cancer care continuum. Currently, there is both limited understanding about perceptions of health IT tools and barriers to their use among cancer genetic counselors. We assessed open-ended responses from a survey conducted among 128 board-certified cancer genetic counselors in the United States. We evaluated the utility of ten health IT tools and perceived barriers to adoption. Responses about characteristics of health IT tools that influence current use (i.e., technology-specific challenges) were deductively analyzed using the diffusion of innovations (DOI) characteristics. Responses about cancer genetic counselors' perceived challenges to adopting health IT tools (i.e., discipline-specific challenges) were inductively coded using a thematic approach. DOI innovation characteristics included mixed perceptions about the relative advantage, complexity, compatibility, trialability, and observability of tools based on the type of tool and perceived end-user. One-third of participants indicated that they were considering adopting or switching health IT tools. Common barriers to adoption included no perceived need for change, lack of organizational infrastructure, cost, and lack of decision-making power. Our findings indicate that addressing barriers to use and adoption of health IT may allow for expansion of these tools among cancer genetic counselors. Integrating health IT is critical for enhancing cancer genetic counselors' capacity to address patient needs and realizing the potential of precision medicine.
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Affiliation(s)
- Caitlin G Allen
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jordon B Ritchie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Steven D Lauzon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brandon M Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
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Ritchie JB, Allen CG, Morrison H, Nichols M, Lauzon SD, Schiffman JD, Hughes Halbert C, Welch BM. Utilization of health information technology among cancer genetic counselors. Mol Genet Genomic Med 2020; 8:e1315. [PMID: 32468681 PMCID: PMC7434745 DOI: 10.1002/mgg3.1315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background Health information technology (IT) is becoming increasingly utilized by cancer genetic counselors (CGCs). We sought to understand the current engagement, satisfaction, and opportunities to adopt new health IT tools among CGCs. Methods We conducted a mixed‐mode survey among 128 board‐certified CGCs using both closed‐ and open‐ended questions. We then evaluated the utilization and satisfaction among 10 types of health IT tools, including the following: cancer screening tool, family health history (FHx) collection tools, electronic health records (EHRs), telegenetics software, pedigree drawing software, genetic risk assessment tools, gene test panel ordering tools, electronic patient education tools, patient communication tools, and family communication tools. Results Seven of 10 health IT tools were used by a minority of CGCs. The vast majority of respondents reported using EHRs (95.2%) and genetic risk assessment tools (88.6%). Genetic test panel ordering software had the highest satisfaction rate (very satisfied and satisfied) at 80.0%, followed by genetic risk assessment tools (77.1%). EHRs had the highest dissatisfaction rate among CGCs at 18.3%. Dissatisfaction with a health IT tool was associated with desire to change: EHRs (p < .001), cancer screening tools (p = .010), genetic risk assessment tools (p = .024), and family history collection tools (p = .026). We found that nearly half of CGCs were considering adopting or changing their FHx tool (49.2%), cancer screening tool (44.9%), and pedigree drawing tool (41.8%). Conclusion Overall, CGCs reported high levels of satisfaction among commonly used health IT tools. Tools that enable the collection of FHx, cancer screening tools, and pedigree drawing software represent the greatest opportunities for research and development.
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Affiliation(s)
- Jordon B Ritchie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlin G Allen
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Heath Morrison
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Steven D Lauzon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua D Schiffman
- University of Utah, Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, USA
| | - Brandon M Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
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Hughes Halbert C, Jefferson M, Ambrose L, Caulder S, Savage SJ. Resiliency and Allostatic Load among Veterans at Risk for Adverse Prostate Cancer Outcomes. Ethn Dis 2020; 30:177-184. [PMID: 32269459 DOI: 10.18865/ed.30.s1.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To examine the relationships between resiliency, sociodemographic factors, and allostatic load among male Veterans. Design/Study Participants Cross-sectional study with minority (African American or Hispanic) and non-minority (White) male Veterans undergoing prostate biopsy. Setting Veterans Affairs Medical Center located in Charleston, SC. Main Outcome Measures Self-reported resilience measured using the two item sub-scale from the Connor-Davidson Resiliency Scale and allostatic load determined from biomarkers measured in blood. Results In this small sample, bounce-back resilience and allostatic load level had a significant negative correlation, while adaptation resilience and allostatic load were slightly correlated, but the association was not statistically significant. Sixty-six percent of participants reported that they were able to adapt and 40% reported they were able to bounce back. Higher income and lower PSA level were significantly correlated with greater adaptation resilience. Minority men were significantly more likely than non-minority men to report that they are able to bounce back. Married men were also significantly more likely than unmarried men to report that they were able to bounce back. Conclusion It may be important to target resiliency training programs to Veterans based on their social determinants and to examine the effects of these programs on allostatic load.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Melanie Jefferson
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Linda Ambrose
- Department of Urology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Susan Caulder
- Department of Urology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Stephen J Savage
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Urology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC.,Department of Urology, Medical University of South Carolina, Charleston, SC
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Jefferson M, Drake RR, Lilly M, Savage SJ, Tucker Price S, Hughes Halbert C. Co-morbidities in a Retrospective Cohort of Prostate Cancer Patients. Ethn Dis 2020; 30:185-192. [PMID: 32269460 DOI: 10.18865/ed.30.s1.185] [Citation(s) in RCA: 4] [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] [Indexed: 11/18/2022] Open
Abstract
Objective To characterize rates of co-morbidity among prostate cancer patients treated with radical prostatectomy and to examine the association between co-morbidity status and race, clinical factors, and health behaviors for cancer control. Design/Study Participants Retrospective cohort study among prostate cancer patients treated with radical prostatectomy. Setting Academic medical center located in the southeastern region of the United States. Main Outcome Measure Patients with at least one of five co-morbid conditions considered were categorized as having a co-morbidity, and those without any were categorized as not having a co-morbid condition. Co-morbid conditions considered were hypertension, diabetes, heart problems, stroke, and high cholesterol, which had been recorded in the electronic medical record as part of their past medical history. Results Fifty-one percent of participants had a co-morbidity, with hypertension being the most common. The average number of co-morbidities among study participants was .87. In a multivariate logistic regression analysis, being diagnosed with prostate cancer within the past four years was associated with an increased likelihood of having a co-morbidity (OR=4.71, 95% CI=2.69, 8.25, P=.0001) compared with diagnosis five or more years ago. Age was also associated with an increased likelihood of having a co-morbidity (OR=1.30, 95% CI=1.005, 1.68, P=.05). In this study cohort, race, stage at diagnosis, and PSA level were not statistically associated with co-morbidity status. Conclusion Better chronic disease management is needed among prostate cancer survivors through more effective survivorship care planning and interventions that promote health behaviors.
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Affiliation(s)
- Melanie Jefferson
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Michael Lilly
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Stephen J Savage
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Sarah Tucker Price
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC
| | - Chanita Hughes Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Zhu V, Lenert L, Bunnell B, Obeid J, Jefferson M, Halbert CH. Automatically Identifying Financial Stress Information from Clinical Notes for Patients with Prostate Cancer. Cancer Res Rep 2020; 1:102. [PMID: 38317775 PMCID: PMC10840090 DOI: 10.61545/crr-1-102] [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: 02/07/2024]
Abstract
Background Financial stress, one of the social determinants, is common among cancer patients because of high out-ofpocket costs for treatment, as well as indirect costs. The National Academy of Medicine (NAM) has advised providers to recognize and discuss cost concerns with patients in order to enhance shared decision-making for treatment and exploration of financial assistant programs. However, financial stress is rarely assessed in clinical practice or research, thus, under-coded and under-documented in clinical practice. Natural language processing (NLP) offers great potential that can automatically extract and process data on financial stress from clinical free text existing in the patient electronic health record (EHR). Methods We developed and evaluated an NLP approach to identify financial stress from clinical narratives for patients with prostate cancer. Of 4,195 eligible prostate cancer patients, we randomly sampled 3,138 patients (75%) as a training dataset (150,990 documents) to develop a financial stress lexicon and NLP algorithms iteratively. The remaining 1,057 patients (25%) were used as a test dataset (55,516 documents) to evaluate the NLP algorithm performance. The common terms representing financial stress were "financial concerns," "unable to afford," "insurance issue," "unemployed," and "financial assistance." Negations were used to exclude false mentions of financial stress. Results Applying both pre- and post-negation, the NLP algorithm identified 209 patients (6.0%) from the training sample and 66 patients (6.2%) with 161 notes from the test sample as having documented financial stress. Two independent domain experts manually reviewed all 161 notes with NLP identified positives and randomly selected 161 notes with NLP-identified negatives, the NLP algorithm yielded 0.86 for precision, 1 for recall, and 0.9.2 for F-score. Conclusions Financial stress information is not commonly documented in the EHR, neither in structured format nor in clinical narratives. However, natural language processing can accurately extract financial stress information from clinical notes when such narrative information is available.
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Affiliation(s)
- V Zhu
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States
| | - L Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States
| | - B Bunnell
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States
| | - J Obeid
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, United States
| | - M Jefferson
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, United States
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
| | - C H Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, United States
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
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Tanner NT, Banas E, Yeager D, Dai L, Hughes Halbert C, Silvestri GA. In-person and Telephonic Shared Decision-making Visits for People Considering Lung Cancer Screening: An Assessment of Decision Quality. Chest 2019; 155:236-238. [PMID: 30616725 DOI: 10.1016/j.chest.2018.07.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Nichole T Tanner
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC; Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
| | - Emerald Banas
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Derik Yeager
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC
| | - Lin Dai
- Department of Public Health, Medical University of South Carolina, Charleston, SC
| | - Chanita Hughes Halbert
- Hollings Cancer Center, Cancer Prevention and Control, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Gerard A Silvestri
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
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Zhu VJ, Lenert LA, Bunnell BE, Obeid JS, Jefferson M, Halbert CH. Correction to: Automatically identifying social isolation from clinical narratives for patients with prostate Cancer. BMC Med Inform Decis Mak 2019; 19:89. [PMID: 31023302 PMCID: PMC6482522 DOI: 10.1186/s12911-019-0815-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Vivienne J Zhu
- Biomedical Informatics Center, Medical University of South Carolina, Chalrleston, SC, USA.
| | - Leslie A Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Chalrleston, SC, USA
| | - Brian E Bunnell
- Biomedical Informatics Center, Medical University of South Carolina, Chalrleston, SC, USA
| | - Jihad S Obeid
- Biomedical Informatics Center, Medical University of South Carolina, Chalrleston, SC, USA
| | - Melanie Jefferson
- Holling Cancer Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes Halbert
- Holling Cancer Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Gonzalez BD, Hoogland AI, Kasting ML, Cragun D, Kim J, Ashing K, Holt CL, Hughes Halbert C, Pal T, Vadaparampil ST. Psychosocial impact of BRCA testing in young Black breast cancer survivors. Psychooncology 2018; 27:2778-2785. [PMID: 30207419 DOI: 10.1002/pon.4887] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/29/2018] [Accepted: 09/08/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Prior studies demonstrating minimal psychological consequences for women receiving genetic counseling/genetic testing (GC/GT) for hereditary breast and ovarian cancer rely on predominantly Caucasian women. We conducted a prospective follow-up of a subset of participants from a population-based study of Black breast cancer (BC) survivors receiving GC/GT for BRCA1 and BRCA2 mutations. METHODS Black women with invasive BC at age ≤ 50 years diagnosed between 2009 and 2012 were recruited through the Florida Cancer Registry. Participants (n = 215, age M = 44.7, SD = 6.2) were offered telephone pre- and post-test GC, a subset completed questionnaires assessing sociodemographic, clinical, and psychosocial variables. RESULTS There were no baseline differences in cancer-related distress, psychological distress, or quality of life between test result groups. Social well-being improved in women receiving negative results (P = .01), but no other outcomes demonstrated significant changes over time between groups. CONCLUSIONS Our study is among the first to demonstrate minimal negative psychosocial outcomes following GC/GT among young Black BC survivors, irrespective of test results.
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Affiliation(s)
| | - Aasha I Hoogland
- Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | | | | | | | | | | | | | - Tuya Pal
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center and Vanderbilt Genetics Institute, Nashville, TN, USA
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Graboyes EM, Ellis MA, Li H, Kaczmar JM, Sharma AK, Lentsch EJ, Day TA, Hughes Halbert C. Racial and Ethnic Disparities in Travel for Head and Neck Cancer Treatment and the Impact of Travel Distance on Survival. Cancer 2018; 124:3181-3191. [PMID: 29932220 DOI: 10.1002/cncr.31571] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients who travel a long distance (≥50 miles) for cancer care have improved outcomes. However, to the authors' knowledge, the prevalence of long travel distances for treatment by patients with head and neck squamous cell carcinoma (HNSCC), and the effect of travel distance on overall survival (OS), remains unknown. METHODS The authors used the National Cancer Data base from 2004 through 2013 to identify patients with HNSCC undergoing definitive treatment. Travel distance for treatment was categorized as short (<12.5 miles), intermediate (12.5-49.9 miles), and long (50-249.9 miles). The primary outcome, OS, was evaluated using Cox shared-frailty modeling. A secondary outcome, factors associated with intermediate and long travel distances, was evaluated using multivariable hierarchical logistic regression. RESULTS Among 118,000 patients with HNSCC, 62,753 (53.2%), 40,644 (34.4%), and 14,603 (12.4%) patients, respectively, traveled short, intermediate, and long distances for treatment. After adjusting for relevant covariates, long travel distance was associated with treatment at academic and high-volume centers. Patients of black race, of Hispanic ethnicity, with Medicaid insurance, and who were treated with nonsurgical treatment were less likely to travel long distances for treatment (P<.001). Traveling a long distance for treatment was associated with improved OS on multivariable analysis (adjusted hazard ratio, 0.93; 95% confidence interval, 0.89-0.96) compared with a short distance. CONCLUSIONS Traveling a long distance for HNSCC treatment is associated with improved survival, especially for patients receiving nonsurgical management. Racial and ethnic disparities in travel for HNSCC treatment exist. As regionalization of care continues, future work should identify and address reasons for racial and ethnic disparities in travel that may prevent access to care at high-volume facilities. Cancer 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Mark A Ellis
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - John M Kaczmar
- Division of Medical Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Chanita Hughes Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Halbert CH, Jefferson M, Nemeth L, Melvin CL, Nietert P, Rice L, Chukwuka KM. Weight loss attempts in a racially diverse sample of primary care patients. Prev Med Rep 2018; 10:167-171. [PMID: 29868362 PMCID: PMC5984215 DOI: 10.1016/j.pmedr.2017.11.009] [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: 01/18/2017] [Revised: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 11/29/2022] Open
Abstract
Despite efforts to promote healthy weight, obesity is at epidemic levels among adults in the US. We examined the prevalence of weight loss attempts among a racially diverse sample of overweight and obese primary care patients (n = 274) based on sociodemographic, clinical and psychological factors, and shared decision-making (SDM) about weight loss/management. This observational study was conducted from December 2015 through January 2017. Data were obtained by self-report via survey. Overall, 64% of participants were attempting to lose weight at the time of survey. No significant differences in current weight loss attempts were found based on racial background, sociodemographic characteristics, or clinical factors. Participants who believed they were obese/overweight (OR = 6.70, 95% CI = 2.86, 15.72, p < 0.0001) or who were ready to lose/manage their weight (OR = 4.50, 95% CI = 1.82, 11.09, p = 0.001) had an increased likelihood of attempting to lose weight. The likelihood of attempting to lose weight increased with greater SDM with providers (OR = 1.54, 95% CI = 1.06, 2.22, p = 0.02). Patient perceptions about their weight, their readiness for weight loss/management, and SDM were associated significantly with weight loss attempts. Obesity is a significant clinical and public health issue. 64% of obese/overweight primary care patients was trying to lose weight. Weight loss attempts did not differ based on race, SES, or clinical factors. Weight loss efforts were associated with perceived obesity status and readiness. Greater shared decision-making was associated with making weight loss efforts.
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Halbert CH, Jefferson M, Melvin CL, Rice L, Chukwuka KM. Provider Advice About Weight Loss in a Primary Care Sample of Obese and Overweight Patients. J Prim Care Community Health 2017. [PMID: 28643551 PMCID: PMC5932732 DOI: 10.1177/2150131917715336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: Primary care providers play an important role in obesity prevention and reduction by advising patients about weight loss strategies. This study examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. Methods: Observational study conducted among primary care patients (n = 282) who completed a survey that measured receipt of provider advice about weight loss/management, chronic health conditions, perceived weight status, and perceptions about shared decision making about weight loss/management. Results: Fifty-nine percent of participants had been advised by their physician to lose weight. Participants who were obese were more likely than those who were overweight to report provider advice (odds ratio [OR] = 1.31, 95% CI = 1.25-4.34, P = .001). Similarly, participants who believed they were obese/overweight had a greater likelihood of reporting provider advice compared with those who did not believe they were obese/overweight (OR = 1.40, 95% CI = 2.43-6.37, P = .0001). Shared decision making about weight loss/management was associated with an increased likelihood of reporting provider advice (OR = 3.30, 95% CI = 2.62-4.12, P = .0001). Conclusions: Patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients. Practice Implications: Continued efforts are needed to enhance provider advice about weight loss/management among obese/overweight patients.
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Affiliation(s)
| | | | - Cathy L Melvin
- 1 Medical University of South Carolina, Charleston, SC, USA
| | - LaShanta Rice
- 1 Medical University of South Carolina, Charleston, SC, USA
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Halbert CH, Bellamy S, Briggs V, Delmoor E, Purnell J, Rogers R, Weathers B, Johnson JC. A comparative effectiveness education trial for lifestyle health behavior change in African Americans. Health Educ Res 2017; 32:207-218. [PMID: 28335038 PMCID: PMC5914351 DOI: 10.1093/her/cyx039] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/06/2017] [Indexed: 06/06/2023]
Abstract
Obesity and excess weight are significant clinical and public health issues that disproportionately affect African Americans because of physical inactivity and unhealthy eating. We compared the effects of alternate behavioral interventions on obesity-related health behaviors. We conducted a comparative effectiveness education trial in a community-based sample of 530 adult African Americans. Outcomes variables were physical activity (PA) and fruit and vegetable intake. Outcomes were evaluated at baseline and 1-month following interventions about shared risk factors for cancer and cardiovascular disease (CVD) (integrated, INT) or CVD only (disease-specific). Significant increases were found in the proportion of participants who met PA guidelines from baseline (47.4%) to follow-up (52.4%) (P = 0.005). In the stratified analysis that were conducted to examine interaction between education and intervention group assignment, this effect was most apparent among participants who had ≤high school education and were randomized to INT (OR = 2.28, 95% CI = 1.04, 5.00, P = 0.04). Completing the intervention was associated with a 1.78 odds of meeting PA guidelines (95% CI = 1.02, 3.10, P = 0.04). Education about risk factors for chronic disease and evidence-based strategies for health behavior change may be useful for addressing obesity-related behaviors among African Americans.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Medical University of South Carolina, Ralph H. Johnson Veteran Administration Medical Center, Charleston, SC 29425, USA
| | - Scarlett Bellamy
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Vanessa Briggs
- Health Promotion Council of Southeastern Pennsylvania, Philadelphia, PA 19102, USA
| | - Ernestine Delmoor
- National Black Leadership Initiative on Cancer, Philadelphia Chapter, Philadelphia, PA 19104, USA
| | | | - Rodney Rogers
- Christ of Calvary Community Development Corporation, Philadelphia, PA 19143, USA
| | - Benita Weathers
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jerry C. Johnson
- Department of Medicine, Division of Geriatric Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Rice LJ, Jefferson M, Briggs V, Delmoor E, Johnson JC, Gattoni-Celli S, Savage SJ, Lilly M, Prasad SM, Kittles R, Halbert CH. Discordance in perceived risk and epidemiological outcomes of prostate cancer among African American men. Prev Med Rep 2017; 7:1-6. [PMID: 28507891 PMCID: PMC5423348 DOI: 10.1016/j.pmedr.2017.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 11/16/2022] Open
Abstract
As guidelines for prostate cancer screening have changed from an annual screening recommendation starting at age 50 to discussing the benefits and harms of screening with health care providers, it is necessary to examine other types of factors that are important to prostate cancer screening decisions among African American men. Perceived risk of developing cancer has been shown to predict cancer control behaviors and is lower among African Americans. We characterized perceived risk of developing prostate cancer among African American men from November 2009 to 2011 and evaluated the relationship between prostate cancer risk perceptions and sociodemographic characteristics, health care experiences, and knowledge and exposure to health information about cancer. Chi square tests and logistic regression were employed to determine independent associations. Overall, men did not believe they were at increased risk of developing prostate cancer; they believed their risk was equivalent to or lower than men the same age. Perceived risk of prostate cancer was associated with income (OR = 0.59, 95% CI = 0.26, 1.34, p = 0.03), hypertension (OR = 2.68, 95% CI = 1.17, 6.16, p = 0.02), and beliefs about the association between race and cancer risk (OR = 2.54, 95% CI = 1.24, 5.20, p = 0.01). Clinic and community-based approaches to improve prostate cancer risk comprehension among African American men are needed to reduce the discordance between perceived risk and epidemiological data on prostate cancer risk factors. Risk education interventions that are developed for African American men may need to integrate information about susceptibility for multiple diseases as well as address strategies for risk reduction and prevention, and chronic disease management. Perceived risk was associated with income, hypertension and race and cancer risk. There is discordance in perceived risk for prostate cancer and risk outcomes data. Clinic and community-based approaches are needed to improve risk comprehension.
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Affiliation(s)
- LaShanta J Rice
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, United States
| | - Vanessa Briggs
- Health Promotion Services, Public Health Management Corporation, Pennsylvania, 260 South Broad Street, Philadelphia, PA 19102, United States
| | - Ernestine Delmoor
- Philadelphia Chapter, National Black Leadership Initiative on Cancer, 1415 N. Broad Street, Suite 221B, Philadelphia, PA 19122, United States
| | - Jerry C Johnson
- Department of Medicine, Division of Geriatrics, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA 19104-2676, United States
| | - Sebastiano Gattoni-Celli
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, United States.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States
| | - Stephen J Savage
- Department of Urology, Medical University of South Carolina, Charleston, SC, United States.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States
| | - Michael Lilly
- Department of Medicine, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Sandip M Prasad
- Department of Urology, Medical University of South Carolina, Charleston, SC, United States.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States
| | - Rick Kittles
- Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC 29425, United States.,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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Abstract
We examined beliefs about genetically targeted care (GTC) among African American men and women in a hospital-based sample and identified sociodemographic, cultural, and clinical factors having significant independent associations with these beliefs. Specifically, beliefs about GTC were evaluated after respondents were randomly primed with a racial or non-racial cue about race and genetics. Despite priming with a racial or non-racial cue, many respondents had positive beliefs about GTC. But, 49% believed that GTC would limit access to medical treatment, 46% believed that people will not trust GTC, and 20% believed that people like them would not benefit from GTC. Racial and non-racial priming did not have significant associations with negative beliefs about GTC. However, cultural beliefs related to temporal orientation were associated significantly with believing that genetically targeted care will limit access to medical treatment. Greater levels of future temporal orientation were associated with a reduced likelihood of endorsing this belief (OR = 0.70, 95% CI = 0.49, 1.01, p = 0.05). Respondents who had a chronic medical condition had an almost three-fold greater likelihood of believing that they would not benefit from GTC (OR = 2.90, 95% CI = 1.00, 8.37, p = 0.05). Greater exposure to information about genetic testing for chronic conditions was also associated with a reduced likelihood of believing that they would not benefit from GTC (OR = 0.40, 95% CI = 0.64, 0.91, p = 0.02). African Americans have diverse beliefs about GTC that should be considered as genetic and genomic services are offered.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Health Equity and Rural Outreach Center, Ralph H. Johnson Department of Medical Affairs, Charleston, SC, USA.
| | - Jasmine A McDonald
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Vadaparampil ST, Christie J, Donovan KA, Kim J, Augusto B, Kasting ML, Holt CL, Ashing K, Halbert CH, Pal T. Health-related quality of life in Black breast cancer survivors with and without triple-negative breast cancer (TNBC). Breast Cancer Res Treat 2017; 163:331-342. [PMID: 28258353 DOI: 10.1007/s10549-017-4173-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/21/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Black women are more likely to develop early-onset (≤50 years) breast cancer (BC) and have the lowest five-year, cause-specific survival rate of any United States (U.S.) racial or ethnic group. These disparities can be attributed partially to the higher rate of triple-negative BC (TNBC) in Blacks. Yet, little is known about health-related quality of life (HRQOL) among Black women with TNBC. METHODS Black women with invasive BC ≤ 50 years were recruited via the Florida Cancer Data System as part of a population-based case-only study of etiology and outcomes of early-onset invasive BC. Of 460 consented participants, a subset of 355 self-reported sociodemographic, clinical, and psychosocial variables. Descriptive analyses included participants with known TNBC (n = 85) or non-TNBC (n = 245) disease. Univariable and multivariable analyses were conducted to examine differences in factors associated with HRQOL. RESULTS In unadjusted analyses, TNBC participants had significantly lower FACT-B total scores (90.1 ± 27.9) compared to non-TNBC (98.5 ± 27.6) participants (p < 0.05). For the TNBC group, multivariable analyses indicated five individual-level, and three systemic-level factors explain 80% of the response variation in HRQOL. For the non-TNBC group, seven individual-level factors and three systemic-level factors account for 76% of the variation in HRQOL scores. CONCLUSIONS Compared to Black women with non-TNBC, TNBC women have worse HRQOL. There are key individual and systemic-level factors that are unique to both groups. Findings can inform future HRQOL interventions to support young Black BC survivors.
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Affiliation(s)
- Susan T Vadaparampil
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA.
| | - Juliette Christie
- University of Maryland, 4200 Valley Drive, Room 1242W, College Park, MD, 20742, USA
| | - Kristine A Donovan
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
| | - Jongphil Kim
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
| | - Bianca Augusto
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
| | - Monica L Kasting
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
| | - Cheryl L Holt
- University of Maryland, 4200 Valley Drive, Room 1242W, College Park, MD, 20742, USA
| | - Kimlin Ashing
- City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | | | - Tuya Pal
- Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, USA
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Halbert CH. Abstract IA41: Emerging Issues in Cancer Screening for Racial and Ethnic Minorities. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-ia41] [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
Cancer screening plays an important role in early detection; detecting cancer in an early stage has important implications for cancer health disparities. Considerable efforts have been made to increase access to early detection services among racial and ethnic minorities in order to improve cancer outcomes in these populations. However, our recent work has shown that racial disparities in cancer screening continue to exist. For instance, about 40% of women in our national random survey of cultural considerations in cancer screening were not up-to-date with mammography guidelines. Our other work with a community-based sample of African American men demonstrated that informed decision-making about PSA testing may be low. Fifty-seven percent of men reported having a PSA test during the past year, but none of the variables that are important to informed decision-making were associated with having annual screening. With respect to lung cancer screening, our recent qualitative research demonstrated that patients have limited discussions with providers about the benefits and limitations of lung cancer screening and had difficulty recalling receipt of information about screening, even though many decided to have low dose computed tomography (LDCT). This may be because of limited knowledge about screening guidelines and low enthusiasm and commitment to LCDT among providers. Providers relied on clinical reminders from the electronic health system to remind them to assess patients for eligibility for LDCT and offer screening. Provider referral to smoking cessation programs was also limited. Provider referral to smoking cessation programs, and delivery of this service, is especially important among high-risk smokers who are candidates for LCDT. Using data from the National Lung Screening Trial (NLST), our research demonstrated that current smokers have an increased risk of lung cancer and all-cause mortality compared to former smokers regardless of randomization to LCDT or the control condition. In addition, smoking abstinence for seven years was associated with a 20% reduction in lung cancer mortality among those screened with chest radiograph. Screening with LCDT and smoking abstinence for 15 years had the greatest mortality risk reduction. African Americans were under-represented in the NLST; therefore, greater efforts are needed to disseminate and implement lung cancer screening in more diverse health care facilities.
Citation Format: Chanita Hughes Halbert. Emerging Issues in Cancer Screening for Racial and Ethnic Minorities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA41.
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Vadaparampil ST, Christie J, Donovan K, Kim J, Augusto B, Holt C, Ashing K, Halbert CH, Pal T. Abstract B26: Health-related quality of life in black breast cancer patients with Triple Negative Breast Cancer (TNBC). Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-b26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Purpose: Black women are more likely to develop early onset (age ≤50 years) breast cancer and have the lowest five year cause specific survival rate of any U.S. racial or ethnic group. The disparity in incidence and survival can be attributed partially to the higher rate of triple negative breast cancer (TNBC) in Blacks. Yet, little is known about health-related quality of life (HRQOL) among Black women with TNBC. Guided by the Contextual Model of HRQOL, the purpose of these analyses is to examine factors associated with HRQOL in patients with TNBC and non-TNBC.
Methods: Black women with invasive breast cancer at age ≤50 years and diagnosed between 2009-2012 were recruited through the Florida State Cancer Registry as part of a population-based case-only study to investigate etiology and outcomes of early-onset invasive breast cancer (n=456). A subset of participants (n=355) consented to complete additional study questions assessing those sociodemographic, clinical, and psychosocial variables selected based on the Contextual Model. The Functional Assessment of Cancer Treatment-Breast (FACT-G) was used to assess HRQOL. Descriptive analyses included those participants confirmed to have either TN or non-TN disease (n=330); univariable and multivariable analyses included participants who met the aforementioned criteria and completed baseline HRQOL data (n=299).
Results: Participants in the TNBC and non-TNBC group were similar (p>0.05) with respect to age (TNBC: 41.4 ±5.9 years; non-TNBC: 42.2 ±6.5) and time since diagnosis (TNBC: 18.5 ±7.0 months; non-TNBC: 19.8±10.1). TNBC participants had lower mean FACT-G total scores (71 ± 22.3) compared to non-TNBC (77 ± 21.6) participants (p<0.05). In the TNBC group, variables significantly associated in multivariable analysis with FACT-G scores included: current health, role limitation, anxiety, income, life stress, collectivism, and fatalism (p<0.05). These three individual-level factors (current health, role limitation, and anxiety) and four systemic-level factors (income, life stress, collectivism, and fatalism) explained 80% of the response variation in HRQOL. In the non-TNBC group, factors significantly associated in multivariable analysis with FACT-G scores included: current health, role limitation, anxiety, depressed affect, cancer worry, income, life stress, social support, and birth country (p<0.05). These five individual-level factors (current health, role limitation, anxiety, depressed affect, and cancer worry) and four system-level factors (income, birth country, life stress, and social support) accounted for 76% of the variation in HRQOL scores.
Conclusions: The Contextual Model of HRQOL provides a useful framework for evaluating HRQOL in Black breast cancer patients; differences based on triple negative disease status suggest possible intervention targets to improve HRQOL in these women. Effective interventions should focus on reducing anxiety at the individual level, with additional consideration for depressed affect, cancer worry, and social support in the non-TNBC group. For patients with TNBC, interventions may include addressing fatalistic cognitions and collectivist attitudes that may adversely affect HRQOL.
Citation Format: Susan T. Vadaparampil, Juliette Christie, Kristine Donovan, Jongphil Kim, Bianca Augusto, Cheryl Holt, Kimlin Ashing, Chanita Hughes Halbert, Tuya Pal. Health-related quality of life in black breast cancer patients with Triple Negative Breast Cancer (TNBC). [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B26.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tuya Pal
- 1Moffitt Cancer Center, Tampa, FL,
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Abstract
Although the association between social context and health has been demonstrated previously, much less is known about network interactions by gender, race/ethnicity, and sociodemographic characteristics. Given the variability in cancer outcomes among groups, research on these relationships may have important implications for addressing cancer health disparities. We examined the literature on social networks and cancer across the cancer continuum among adults. Relevant studies (N=16) were identified using two common databases: PubMed and Google Scholar. Most studies used a prospective cohort study design (n=9), included women only (n=11), and were located in the United States (n=14). Seventy-five percent of the studies reviewed used a validated scale or validated items to measure social networks (n=12). Only one study examined social network differences by race, 57.1% (n=8) focused on breast cancer alone, 14.3% (n=2) explored colorectal cancer or multiple cancers simultaneously, and 7.1% (n=1) only prostate cancer. More than half of the studies included multiple ethnicities in the sample, while one study included only low-income subjects. Despite findings of associations between social networks and cancer survival, risk, and screening, none of the studies utilized social networks as a mechanism for reducing health disparities; however, such an approach has been utilized for infectious disease control. Social networks and the support provided within these networks have important implications for health behaviors and ultimately cancer disparities. This review serves as the first step toward dialog on social networks as a missing component in the social determinants of cancer disparities literature that could move the needle upstream to target adverse cancer outcomes among vulnerable populations.
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Affiliation(s)
- L J Rice
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.
| | - C H Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, United States
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Halbert CH, Melvin C, Briggs V, Delmoor E, Rice LJ, Lynch C, Jefferson M, Johnson JC. Neighborhood Satisfaction and Colorectal Cancer Screening in a Community Sample of African Americans. J Community Health 2016; 41:38-45. [PMID: 26184107 DOI: 10.1007/s10900-015-0062-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Social determinants are important to cancer screening among African Americans. To evaluate the association between social determinants (e.g., psychological characteristics, perceived social environment, cultural beliefs such as present temporal orientation) and colorectal cancer (CRC) screening among African Americans. African American adults (n = 262) ages 50-75 completed a telephone interview. Multivariate logistic regression analysis was used to identify factors having significant independent associations with CRC screening. Only 57% of respondents reported having CRC screening. The likelihood of screening increased with greater neighborhood satisfaction (OR = 1.38, 95% CI = 1.01, 1.90, p = 0.04), older age (OR = 1.75, 95% CI = 1.24, 2.48, p = 0.002), greater self-efficacy (OR = 2.73, 95% CI = 1.40, 5.35, p = 0.003), and health care provider communication (OR = 10.78, 95% CI = 4.85, 29.94, p = 0.0001). Community resources are important precursors to CRC screening and outcomes among African Americans. In addition to addressing psychological factors and patient-provider communication, efforts to ensure the availability of quality health care facilities that provide CRC screening in the neighborhoods where African Americans live are needed.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Center for Population Health and Outcomes, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA. .,Ralph H. Johnson Veterans Administration Medical Center, 68 President Street, Suite BE103, Charleston, SC, 29425, USA.
| | - Cathy Melvin
- Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA.,Department of Public Health Sciences, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
| | - Vanessa Briggs
- Health Promotion Services, Public Health Management Corporation, Pennsylvania, 260 South Broad Street, Philadelphia, PA, 19102, USA
| | - Ernestine Delmoor
- Philadelphia Chapter, National Black Leadership Initiative on Cancer, 1415 N. Broad Street, Suite 221B, Philadelphia, PA, 19122, USA
| | - LaShanta J Rice
- Department of Psychiatry and Behavioral Sciences, Center for Population Health and Outcomes, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
| | - Cheryl Lynch
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA.,Ralph H. Johnson Veterans Administration Medical Center, 135 Rutledge Ave, Charleston, SC, 29425, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Center for Population Health and Outcomes, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA
| | - Jerry C Johnson
- Division of Geriatrics, Department of Medicine, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA, 19104-2676, USA
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Melvin CL, Jefferson MS, Rice LJ, Cartmell KB, Halbert CH. Predictors of Participation in Mammography Screening among Non-Hispanic Black, Non-Hispanic White, and Hispanic Women. Front Public Health 2016; 4:188. [PMID: 27656640 PMCID: PMC5012250 DOI: 10.3389/fpubh.2016.00188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/23/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Many factors influence women's decisions to participate in guideline-recommended screening mammography. We evaluated the influence of women's socioeconomic characteristics, health-care access, and cultural and psychological health-care preferences on timely mammography screening participation. MATERIALS AND METHODS A random digit dial survey of United States non-Hispanic Black, non-Hispanic White, and Hispanic women aged 40-75, from January to August 2009, determined self-reported time of most recent mammogram. Screening rates were assessed based on receipt of a screening mammogram within the prior 12 months, the interval recommended at the time by the American Cancer Society. RESULTS Thirty-nine percent of women reported not having a mammogram within the last 12 months. The odds of not having had a screening mammography were higher for non-Hispanic White women than for non-Hispanic Black (OR = 2.16, 95% CI = 0.26, 0.82, p = 0.009) or Hispanic (OR = 4.17, 95% CI = 0.12, 0.48, p = 0.01) women. Lack of health insurance (OR = 3.22, 95% CI = 1.54, 6.73, p = 0.002) and lack of usual source of medical care (OR = 3.37, 95% CI = 1.43, 7.94, p = 0.01) were associated with not being screened as were lower self-efficacy to obtain screening (OR = 2.43, 95% CI = 1.26, 4.73, p = 0.01) and greater levels of religiosity and spirituality (OR = 1.42, 95% CI = 1.00, 2.00, p = 0.05). Neither perceived risk nor present temporal orientation was significant. DISCUSSION Odds of not having a mammogram increased if women were uninsured, without medical care, non-Hispanic White, older in age, not confident in their ability to obtain screening, or held passive or external religious/spiritual values. Results are encouraging given racial disparities in health-care participation and suggest that efforts to increase screening among minority women may be working.
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Affiliation(s)
- Cathy L. Melvin
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie S. Jefferson
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - LaShanta J. Rice
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Chanita Hughes Halbert
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC, USA
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Halbert CH, McDonald J, Vadaparampil S, Rice L, Jefferson M. Conducting Precision Medicine Research with African Americans. PLoS One 2016; 11:e0154850. [PMID: 27441706 PMCID: PMC4956119 DOI: 10.1371/journal.pone.0154850] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/20/2016] [Indexed: 11/18/2022] Open
Abstract
Importance Precision medicine is an approach to detecting, treating, and managing disease that is based on individual variation in genetic, environmental, and lifestyle factors. Precision medicine is expected to reduce health disparities, but this will be possible only if studies have adequate representation of racial minorities. Objective It is critical to anticipate the rates at which individuals from diverse populations are likely to participate in precision medicine studies as research initiatives are being developed. We evaluated the likelihood of participating in a clinical study for precision medicine. Design, Setting, Participants Observational study conducted between October 2010 and February 2011 in a national sample of African Americans. Main Outcome Measure Intentions to participate in a government sponsored study that involves providing a biospecimen and generates data that could be shared with other researchers to conduct future studies. Results One third of respondents would participate in a clinical study for precision medicine. Only gender had a significant independent association with participation intentions. Men had a 1.86 (95% CI = 1.11, 3.12, p = 0.02) increased likelihood of participating in a precision medicine study compared to women in the model that included overall barriers and facilitators. In the model with specific participation barriers, distrust was associated with a reduced likelihood of participating in the research described in the vignette (OR = 0.57, 95% CI = 0.34, 0.96, p = 0.04). Conclusion and Relevance African Americans may have low enrollment in PMI research. As PMI research is implemented, extensive efforts will be needed to ensure adequate representation. Additional research is needed to identify optimal ways of ethically describing precision medicine studies to ensure sufficient recruitment of racial minorities.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
- Ralph H. Johnson Veteran’s Administration Medical Center, Charleston, SC, United States of America
- * E-mail:
| | - Jasmine McDonald
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | | | - LaShanta Rice
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States of America
| | - Melanie Jefferson
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
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Tanner NT, Kanodra NM, Gebregziabher M, Payne E, Halbert CH, Warren GW, Egede LE, Silvestri GA. The Association between Smoking Abstinence and Mortality in the National Lung Screening Trial. Am J Respir Crit Care Med 2016; 193:534-41. [PMID: 26502000 DOI: 10.1164/rccm.201507-1420oc] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Smoking is the largest contributor to lung cancer risk, and those who continue to smoke after diagnosis have a worse survival. Screening for lung cancer with low-dose computed tomography (LDCT) reduces mortality in high-risk individuals. Smoking cessation is an essential component of a high-quality screening program. OBJECTIVES To quantify the effects of smoking history and abstinence on mortality in high-risk individuals who participated in the NLST (National Lung Screening Trial). METHODS This is a secondary analysis of a randomized controlled trial (NLST). MEASUREMENTS AND MAIN RESULTS Measurements included self-reported demographics, medical and smoking history, and lung cancer-specific and all-cause mortality. Cox regression was used to study the association of mortality with smoking status and pack-years. Kaplan-Meier survival curves were examined for differences in survival based on trial arm and smoking status. Current smokers had an increased lung cancer-specific (hazard ratio [HR], 2.14-2.29) and all-cause mortality (HR, 1.79-1.85) compared with former smokers irrespective of screening arm. Former smokers in the control arm abstinent for 7 years had a 20% mortality reduction comparable with the benefit reported with LDCT screening in the NLST. The maximum benefit was seen with the combination of smoking abstinence at 15 years and LDCT screening, which resulted in a 38% reduction in lung cancer-specific mortality (HR, 0.62; 95% confidence interval, 0.51-0.76). CONCLUSIONS Seven years of smoking abstinence reduced lung cancer-specific mortality at a magnitude comparable with LDCT screening. This reduction was greater when abstinence was combined with screening, highlighting the importance of smoking cessation efforts in screening programs.
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Affiliation(s)
- Nichole T Tanner
- 1 Division of Pulmonary, Critical Care and Sleep Medicine.,2 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina
| | | | - Mulugeta Gebregziabher
- 3 Department of Public Health Sciences.,2 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina
| | | | - Chanita Hughes Halbert
- 4 Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center.,2 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina
| | - Graham W Warren
- 5 Department of Radiation Oncology.,6 Department of Cell and Molecular Pharmacology, and
| | - Leonard E Egede
- 7 Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; and.,2 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina
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Halbert CH, Gattoni-Celli S, Savage S, Prasad SM, Kittles R, Briggs V, Delmoor E, Rice LJ, Jefferson M, Johnson JC. Ever and Annual Use of Prostate Cancer Screening in African American Men. Am J Mens Health 2016; 11:99-107. [PMID: 26240090 DOI: 10.1177/1557988315596225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since prostate cancer continues to disproportionately affect African American men in terms of incidence, morbidity, and mortality, prostate-specific antigen (PSA) screening plays an important role in early detection, especially when men engage in informed decision making to accept or decline this test. The authors evaluated utilization of PSA testing among African American men based on factors that are important components of making informed decisions. Utilization of PSA testing was evaluated based on whether men had ever had PSA testing and PSA testing during the past year in a community-based sample of African American men ages 50 to 75 ( n = 132). Overall, 64% of men ( n = 85) reported that they had ever had a PSA test; the mean ( SD) age for first use of PSA testing was 47.7 ( SD = 7.4). The likelihood of ever having a PSA test increased significantly with physician communication (odds ratio [OR] = 14.2; 95% confidence interval [CI] = 4.20, 48.10; p = .0001) and with having an annual household income that was greater than $20,000 (OR = 9.80; 95% CI = 3.15, 30.51; p = .0001). The odds of ever having a PSA test were also decreased with each unit increase in future temporal orientation (OR = 0.66; 95% CI = 0.47, 0.93; p = .02). Of the men who had ever had PSA testing, 57% were screened during the past year. Only health insurance status had a significant independent association with having annual PSA testing (OR = 5.10; 95% CI = 1.67, 15.60; p = .004). Different factors were associated significantly with ever having PSA testing and annual testing among African American men. African American men may not be making an informed decision about prostate cancer screening.
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Affiliation(s)
- Chanita Hughes Halbert
- 1 Medical University of South Carolina, Charleston, SC, USA.,2 Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Sebastiano Gattoni-Celli
- 1 Medical University of South Carolina, Charleston, SC, USA.,2 Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Stephen Savage
- 1 Medical University of South Carolina, Charleston, SC, USA.,2 Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Sandip M Prasad
- 1 Medical University of South Carolina, Charleston, SC, USA.,2 Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | | | - Vanessa Briggs
- 4 Health Promotion Council of Southeastern Pennsylvania, Philadelphia, PA, USA
| | - Ernestine Delmoor
- 5 Philadelphia Chapter, National Black Leadership Initiative on Cancer, Philadelphia, PA, USA
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Hardiman G, Savage SJ, Hazard ES, Wilson RC, Courtney SM, Smith MT, Hollis BW, Halbert CH, Gattoni-Celli S. Systems analysis of the prostate transcriptome in African-American men compared with European-American men. Pharmacogenomics 2016; 17:1129-1143. [PMID: 27359067 DOI: 10.2217/pgs-2016-0025] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM African-Americans (AA) have increased prostate cancer risk and a greater mortality rate than European-Americans (EA). AA exhibit a high prevalence of vitamin D deficiency. We examined the global prostate transcriptome in AA and EA, and the effect of vitamin D3 supplementation. PATIENTS & METHODS Twenty-seven male subjects (ten AA and 17 EA), slated to undergo prostatectomy were enrolled in the study. Fourteen subjects received vitamin D3 (4000 IU daily) and 13 subjects received placebo for 2 months prior to surgery. RESULTS AA show higher expression of genes associated with immune response and inflammation. CONCLUSION Systems level analyses support the concept that Inflammatory processes may contribute to disease progression in AA. These transcripts can be modulated by a short course of vitamin D3 supplementation.
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Affiliation(s)
- Gary Hardiman
- Department of Medicine & Public Health, Medical University of South Carolina, Charleston, SC, USA.,Center for Genomics Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen J Savage
- Department of Urology.,Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - E Starr Hazard
- Center for Genomics Medicine, Medical University of South Carolina, Charleston, SC, USA.,Library Science and Informatics, Medical University of South Carolina, Charleston, SC, USA
| | - Robert C Wilson
- Center for Genomics Medicine, Medical University of South Carolina, Charleston, SC, USA.,Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sean M Courtney
- Center for Genomics Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Michael T Smith
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Bruce W Hollis
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes Halbert
- Ralph H Johnson VA Medical Center, Charleston, SC, USA.,Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sebastiano Gattoni-Celli
- Ralph H Johnson VA Medical Center, Charleston, SC, USA.,Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
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