bims-cahedi Biomed News
on Cancer health disparities
Issue of 2023–04–16
twelve papers selected by
Keshav K. Singh, University of Alabama at Birmingham
  1. Reaching Populations to Address Disparities in Cancer Care Delivery: Results From a Six-Site Initiative.
  2. Inequities Among Cancer Caregivers with Diverse Identities: A Review of the Literature and Future Directions.
  3. A framework for setting enrollment goals to ensure participant diversity in sponsored clinical trials in the United States.
  4. Oral Health Disparities and Inequities in Older Adults.
  5. Prostate cancer metastasis and health disparities: a systematic review.
  6. India's social health activists are tackling cancer in rural communities.
  7. The role of sovereignty in Indigenous community-based health interventions: A qualitative metasynthesis.
  8. Cervical Cancer Knowledge and Screening Patterns in Zuni Pueblo Women in the Southwest United States.
  9. Association of the COVID-19 Pandemic and Changes in Patterns of Cancer-Related Mortality in the United States.
  10. Disparities in Prostate Cancer Diagnoses Among Persons Experiencing Homelessness.
  11. Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums.
  12. Social Determinants and Participation in Fecal Occult Blood Test Based Colorectal Cancer Screening: A Qualitative Systematic Review and Meta-Synthesis.
  1. J Natl Compr Canc Netw. 2023 Apr 11. 1-6
    Reaching Populations to Address Disparities in Cancer Care Delivery: Results From a Six-Site Initiative.
    Noël Arring, Christopher R Friese, Bidisha Ghosh, Marita Titler, Heidi Hamann, Sanja Percac-Lima, Adrian Sandra Dobs, Michelle J Naughton, Pooja Mishra, Melissa A Simon, Bingxin Chen, Electra D Paskett, Robert J Ploutz-Snyder, Martha Quinn, Debra L Barton.
       BACKGROUND: Large segments of the US population do not receive quality cancer care due to pervasive and systemic inequities, which can increase morbidity and mortality. Multicomponent, multilevel interventions can address inequities and improve care, but only if they reach communities with suboptimal access. Intervention studies often underenroll individuals from historically excluded groups.
    METHODS: The Alliance to Advance Patient-Centered Cancer Care includes 6 grantees across the United States who implemented unique multicomponent, multilevel intervention programs with common goals of reducing disparities, increasing engagement, and improving the quality of care for targeted populations. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework informed the evaluation efforts across sites. Each Alliance site identified their intended populations, which included underrepresented minorities (eg, Black and Latinx persons), individuals who prefer a language other than English, and rural residents. We evaluated the demographic characteristics of participants to determine program reach.
    RESULTS: Between 2018 and 2020, a total of 2,390 of 5,309 potentially eligible participants were enrolled across the 6 sites. The proportion of enrolled individuals with selected characteristics included 38% (n=908) Black adults, 24% (n=574) Latinx adults, 19% (n=454) preferring a language other than English, and 30% (n=717) rural residents. The proportion of those enrolled who were the intended population was commensurate to the proportion with desired characteristics in those identified as potentially eligible.
    CONCLUSIONS: The grantees met or exceeded enrollments from their intended populations who have been underserved by quality cancer care into patient-centered intervention programs. Intentional application of recruitment/engagement strategies is needed to reach individuals from historically underserved communities.
    Keywords:  disparities in cancer care delivery; quality improvement; underrepresented minorities
    DOI:  https://doi.org/10.6004/jnccn.2023.7006
  2. Curr Oncol Rep. 2023 Apr 12.
    Inequities Among Cancer Caregivers with Diverse Identities: A Review of the Literature and Future Directions.
    Kelly R Tan, Austin R Waters, Qi Chen, Bailey A Hendricks, Lorinda A Coombs, Erin E Kent.
       PURPOSE OF REVIEW: The number of older adults with cancer relying on support from caregivers continues to increase. Health disparities in older adults with cancer often extend to their caregivers. This review aims to assess the state of cancer caregiving research in historically underrepresented diverse populations and provide recommendations for future research and policy.
    RECENT FINDINGS: Research on caregivers of older adults with cancer from diverse backgrounds has primarily been descriptive. Health disparities for historically underrepresented caregivers (LGBTQ + , BIPOC, rural, young adults, youth) exist across several dimensions (e.g., financial, mental, and physical health, and access to caregiver support). Few published studies have closely examined the unique experiences of these caregivers nor provided culturally appropriate tailored interventions. Health equity research within caregiving populations is in its infancy. Priorities for future work should focus on identifying modifiable targets for intervention, changing systems-level processes in acknowledging and supporting caregivers, and creating policies that reduce financial inequities of caregiving.
    Keywords:  Cancer; Care partner; Caregiver; Health disparities; Health equity; Underrepresented
    DOI:  https://doi.org/10.1007/s11912-023-01415-3
  3. Contemp Clin Trials. 2023 Apr 11. pii: S1551-7144(23)00107-6. [Epub ahead of print] 107184
    A framework for setting enrollment goals to ensure participant diversity in sponsored clinical trials in the United States.
    Mark R Cullen, Adina R Lemeshow, Sandra Amaro, Elisa V Bandera, Lisa A Cooper, Ichiro Kawachi, Joseph Lunyera, Laura McKinley, Christopher S Poss, Melinda M Rottas, Steve Schachterle, Peter F Thadeio, Leo J Russo.
       BACKGROUND: Diversity in clinical trials (CTs) has potential to improve health equity and close health disparities. Underrepresentation of historically underserved groups compromises the generalizability of trial findings to the target population, hinders innovation, and contributes to low accrual. Aim of this study was to establish a transparent and reproducible process for setting trial diversity enrollment goals informed by disease epidemiology.
    METHOD: An advisory board of epidemiologists with expertise in health disparities, equity, diversity, and social determinants of health was convened to evaluate and strengthen the initial goal-setting framework. Data sources used were the epidemiologic literature, US Census, and real-world data (RWD); limitations were considered and addressed where appropriate. Framework was intentionally designed to safeguard against the underrepresentation of groups that have been medically underserved historically. A stepwise approach was created with Y/N decisions based on empirical data.
    RESULTS: We compared race and ethnicity distributions of six diseases from Pfizer's portfolio chosen to represent different therapeutic areas (multiple myeloma, fungal infections, Crohn's disease, Gaucher disease, COVID-19, and Lyme disease) in the RWD to the distributions in the US Census and established trial enrollment goals. Enrollment goals for potential CTs were based on RWD for multiple myeloma, Gaucher disease, and COVID-19; for fungal infections, Crohn's disease, and Lyme disease, enrollment goals were based on the Census.
    CONCLUSIONS: We developed a transparent and reproducible framework for setting CT diversity enrollment goals. We noted limitations due to data sources to be mitigated and several ethical decisions to be considered to set equitable enrollment goals.
    Keywords:  Clinical trials; Diversity; Equity; Ethnicity; Race; Underrepresentation
    DOI:  https://doi.org/10.1016/j.cct.2023.107184
  4. Clin Geriatr Med. 2023 May;pii: S0749-0690(23)00007-1. [Epub ahead of print]39(2): 207-223
    Oral Health Disparities and Inequities in Older Adults.
    Michelle M Henshaw, Steven Karpas.
      The number of individuals 65 and older living in the United States is increasing substantially and becoming more racially and ethnically diverse. This shift will affect the demographics of the patient population seeking dental care. It will also impact the future treatment needs of older adults. In older adults, similar to the general adult population, oral health disparities continue to exist related to race, ethnicity, gender, and socioeconomic level. Dental practitioners must understand these changes in order to meet the challenges of providing oral health care to the increasing numbers of diverse, medically compromised, and cognitively impaired older adults.
    Keywords:  Dental caries; Disparities; Inequities; Older adults; Oral cancer; Oral health; Periodontal disease; Tooth loss
    DOI:  https://doi.org/10.1016/j.cger.2023.01.007
  5. Prostate Cancer Prostatic Dis. 2023 Apr 12.
    Prostate cancer metastasis and health disparities: a systematic review.
    Yusuf Liadi, Taaliah Campbell, Precious Dike, Maxine Harlemon, Bethtrice Elliott, Valerie Odero-Marah.
       BACKGROUND: Prostate cancer (PCa), one of the most prevalent malignancies affecting men, significantly contributes to increased mortality rates worldwide. While the causative death is due to advanced metastatic disease, this occurrence disproportionately impacts men of African descent compared to men of European descent. In this review, we describe potential mechanisms underlying PCa metastases disparities and current treatments for metastatic disease among these populations, differences in treatment outcomes, and survival rates, in hopes of highlighting a need to address disparities in PCa metastases.
    METHODS: We reviewed existing literature using databases such as PubMed, Google Scholar, and Science Direct using the following keywords: "prostate cancer metastases", "metastatic prostate cancer disparity", "metastatic prostate cancer diagnosis and treatment", "prostate cancer genetic differences and mechanisms", "genetic differences and prostate tumor microenvironment", and "men of African descent and access to clinical treatments". The inclusion criteria for literature usage were original research articles and review articles.
    RESULTS: Studies indicate unique genetic signatures and molecular mechanisms such as Epithelial-Mesenchymal Transition (EMT), inflammation, and growth hormone signaling involved in metastatic PCa disparities. Clinical studies also demonstrate differences in treatment outcomes that are race-specific, for example, patients of African descent have a better response to enzalutamide and immunotherapy yet have less access to these drugs as compared to patients of European descent.
    CONCLUSIONS: Growing evidence suggests a connection between a patient's genetic profile, the prostate tumor microenvironment, and social determinants of health that contribute to the aggressiveness of metastatic disease and treatment outcomes. With several potential pathways highlighted, the limitations in current diagnostic and therapeutic applications that target disparity in PCa metastases warrant rigorous research attention.
    DOI:  https://doi.org/10.1038/s41391-023-00667-1
  6. Nat Med. 2023 Apr 10.
    India's social health activists are tackling cancer in rural communities.
    Meenakshi J.
      
    DOI:  https://doi.org/10.1038/s41591-023-02285-9
  7. Am J Community Psychol. 2023 Apr 14.
    The role of sovereignty in Indigenous community-based health interventions: A qualitative metasynthesis.
    Gillian Joseph.
      Indigenous peoples around the world suffer from health disparities attributed to a plethora of risk factors and social determinants of health stemming from colonialism and systemic oppression. Community-based health interventions have been identified as a means for addressing and reducing Indigenous health disparities by allowing for Indigenous sovereignty to be respected and centered. However, sovereignty relating to Indigenous health and well-being is underresearched. The present article explores the role of sovereignty in Indigenous community-based health interventions. A qualitative metasynthesis was conducted among 14 primary research studies co-authored by Indigenous people describing and evaluating Indigenous community-based health interventions. Five conceptual themes emerged as aspects of sovereignty which benefit Indigenous health and well-being outcomes: integration of culture; relocation of knowledge; connectedness; self-actualization; and stewardship. Implications are discussed, with the goal of creating a decolonial framework rooted in Indigenous epistemologies and perspectives for how sovereignty impacts Indigenous health, as well as strengthening a clear need for further research on and praxis of sovereignty in Indigenous healthcare.
    Keywords:  Indigenous; community participatory research; decolonial methodologies; health interventions; qualitative metasynthesis; sovereignty
    DOI:  https://doi.org/10.1002/ajcp.12670
  8. J Cancer Educ. 2023 Apr 13.
    Cervical Cancer Knowledge and Screening Patterns in Zuni Pueblo Women in the Southwest United States.
    Kate Cartwright, Mikaela Kosich, Madison Gonya, Deborah Kanda, Samantha Leekity, Judith Sheche, Nicholas Edwardson, V Shane Pankratz, Shiraz I Mishra.
      American Indian women experience cervical cancer disparities, including later-stage diagnosis and a higher cervical cancer mortality rate. These disparities are interconnected and linked to cervical cancer screening disparities. Cervical cancer when identified early is highly treatable. Individual- and health system-level factors often contribute to gaps in cervical cancer screening. To better understand the source of these inequities experienced by American Indian women, specifically Zuni women, this paper examines how knowledge about cervical cancer and related risk factors is linked to cervical cancer screening for Zuni women using primary data gathered by the Zuni Health Initiative in 2020 and 2021. We find that of the women who completed the survey (n = 171), women with greater cervical cancer knowledge are statistically significantly more likely to have received cervical cancer screening. Closer examination of knowledge on the specific risk factors for cervical cancer provides evidence upon which to develop a cervical cancer education intervention.
    Keywords:  American Indian/Alaska Native; Cancer screening; Cervical cancer; Health equity
    DOI:  https://doi.org/10.1007/s13187-023-02295-8
  9. JCO Oncol Pract. 2023 Apr 11. OP2200522
    Association of the COVID-19 Pandemic and Changes in Patterns of Cancer-Related Mortality in the United States.
    Jingxuan Zhao, Xuesong Han, Kimberly D Miller, Zhiyuan Zheng, Leticia Nogueira, Farhad Islami, Ahmedin Jemal, K Robin Yabroff.
       PURPOSE: This study examined changes in patterns of cancer-related deaths during the first year of the coronavirus disease 2019 pandemic in the United States.
    METHODS: We identified cancer-related deaths, defined as deaths attributable to cancer as the primary cause (underlying cause) or deaths with cancer documented as one of the multiple contributing factors (contributing cause) from the Multiple Cause of Death database (2015-2020). We compared age-standardized cancer-related annual and monthly mortality rates for January-December 2020 (first pandemic year) to January-December 2015-2019 (prepandemic) overall and stratified by sex, race/ethnicity, urban rural residence, and place of death.
    RESULTS: We found that the death rate (per 100,000 person-years) with cancer as the underlying cause was lower in 2020 compared with 2019 (144.1 v 146.2), continuing the past trend observed in 2015-2019. By contrast, the death rate with cancer as a contributing cause was higher in 2020 than in 2019 (164.1 v 162.0), reversing the continuously decreasing trend from 2015 to 2019. We projected 19,703 more deaths with cancer as a contributing cause than expected on the basis of historical trends. Mirroring pandemic peaks, the monthly death rates with cancer as a contributing cause first increased in April 2020 (rate ratio [RR], 1.03; 95% CI, 1.02 to 1.04), subsequently declined in May and June 2020, and then increased again each month from July through December 2020 compared with 2019, with the highest RR in December (RR, 1.07; 95% CI, 1.06 to 1.08).
    CONCLUSION: Death rates with cancer as the underlying cause continued to decrease in 2020 despite the increase in death rates with cancer as a contributing cause in 2020. Ongoing monitoring of long-term cancer-related mortality trends is warranted to assess effects of delays in cancer diagnosis and receipt of care during the pandemic.
    DOI:  https://doi.org/10.1200/OP.22.00522
  10. Eur Urol. 2023 Apr 06. pii: S0302-2838(23)02704-5. [Epub ahead of print]
    Disparities in Prostate Cancer Diagnoses Among Persons Experiencing Homelessness.
    Zachary S Mayo, Sean M Parker, Sarah S Kilic, Jeremy Weleff, Michael Phelan, Omar Y Mian, Kevin L Stephans, John H Suh, Rahul D Tendulkar.
      
    DOI:  https://doi.org/10.1016/j.eururo.2023.03.024
  11. J Cancer Surviv. 2023 Apr 11.
    Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums.
    Jill M Binkley, Sheryl Gabram, Janae Finley, Dawnovise Fowler, Lisa VanHoose, Lauren E McCullough.
       PURPOSE: Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors. Black BC survivors have more significant survivorship issues and a greater burden of illness than White counterparts. Barriers to rehabilitation exist for all BC survivors but are magnified in Black BC survivors. The purpose of this qualitative research was to document patient, clinician, and researchers' perceptions surrounding contributing factors, lived experiences, and potential solutions to racial disparity in BC survivorship.
    METHODS: A narrative approach was utilized to identify themes from a series of four virtual healthcare provider forums that explored lived personal and professional experiences, issues, and potential solutions surrounding racial disparity in BC survivorship. Forums included perspectives of patients, healthcare providers, researchers, and stakeholders in the BC field. An independent thematic analysis was performed by the investigators, all of whom have emic perspectives with respect to race and/or BC.
    RESULTS: Three main themes were identified related to racial disparity in BC survivorship: (1) societal and cultural contributing factors, (2) contribution of healthcare providers and systems, and (3) models of care and research considerations.
    CONCLUSIONS: The findings provide compelling documentation of lived personal and professional experiences of racial disparity in BC survivorship. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black individuals following a BC diagnosis.
    IMPLICATIONS FOR CANCER SURVIVORS: Increased awareness related to racial disparity in BC survivorship among survivors, healthcare providers, and researchers will contribute to health equity and improved outcomes for Black individuals.
    Keywords:  Breast cancer outcomes; Breast cancer rehabilitation; Breast cancer survivorship; Health equity; Navigation; Oncology physical therapy; Prospective surveillance; Racial disparity
    DOI:  https://doi.org/10.1007/s11764-023-01373-6
  12. Health Promot J Austr. 2023 Apr 11.
    Social Determinants and Participation in Fecal Occult Blood Test Based Colorectal Cancer Screening: A Qualitative Systematic Review and Meta-Synthesis.
    Nicole Marinucci, Naomi Moy, Natasha Koloski, Ayesha Shah, Glenn Austin, Rebekah Russell-Bennett, Jacquie McGraw, Uwe Dulleck, Gerald Holtmann.
       ISSUE ADDRESSED: Colorectal cancer (CRC) screening through Fecal Occult Blood Testing (FOBT) has saved thousands of lives globally with multiple countries adopting comprehensive population wide screening programs. Participation rates in FOBT based CRC screening for the socially and economically disadvantaged remains low. The aim of this systematic review is to explore empirical evidence that will guide targeted interventions to improve participation rates within priority populations.
    METHODS: PubMed, Embase, Scopus, Cinahl and PsycInfo were systematically searched from inception to June 22, 2022. Eligible studies contained qualitative evidence identifying barriers to FOBT based CRC screening for populations impacted by the social determinants of health. An inductive thematic synthesis approach was applied using grounded theory methodology, to explore descriptive themes and interpret these into higher order analytical constructs and theories.
    RESULTS: 8,501 publications were identified and screened. 48 studies from 10 countries were eligible for inclusion, representing 2,232 subjects. Coding within included studies resulted in 30 key descriptive themes with a thematic frequency greater than 10%. Coded themes applied to four overarching, interconnected barriers driving inequality for priority populations: social, behavioural, economic and technical/interfaces. SO WHAT?: This study has highlighted the need for stronger patient/provider relationships to mitigate barriers to FOBT screening participation for diverse groups. Findings can assist health professionals and policy makers adress the systemic exclusion of priority populations in cancer screening by moving beyond the responsibility of the individual to a focus on addressing the information asymmetry driving low value perceptions. This article is protected by copyright. All rights reserved.
    Keywords:  Cancer Screening; Colorectal cancer screening; FOBT; Preventative Health; health equity; public health
    DOI:  https://doi.org/10.1002/hpja.732
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