Abstract
Addressing racial disparities in breast cancer treatment delays: An application of group model building
Faustine Williams1, Nancy Zoellner, MPH2, Maisha Flannel, Lailea Noel, David Habif Jr., Peter Hovamnd and Sarah Gehlert
(1)Washington University in St. Louis School of Medicine, St. Louis, MO, (2)George Warren Brown School of Social Work at Washington University, St. Louis, MO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Racial disparities in breast cancer (BC) in St. Louis, Missouri, are consistent with patterns seen throughout the US, however, there is great regional variation in mortality. Women with BC residing in North St. Louis, a predominantly black community, experience the highest rates of mortality.
Methods: Group model building (GMB) is a participatory method for actively engaging stakeholders in modeling a complex system. Three 2-hour GMB sessions were conducted with: (1) community support members (n=6), (2) black women from the community (n=34), and (3) both groups combined. The objective of sessions 1 and 2 was to elicit factors contributing to BC diagnosis and treatment delays and develop a dynamic hypothesis to explain the disparities in the form of a causal loop diagram (CLD), a causal map that visualizes how system variables are interrelated. In the third session participants evaluated a synthesized CLD and identified places to intervene.
Results: Women built a CLD that included subsystems mental health, fear, access to care, income, religion/spirituality, social support, knowledge on breast health and personal mindset on health/life. These subsystems are causally-linked and include feedback loops, providing explanations for trends in BC diagnosis and treatment delays in St. Louis. Women also identified a set of recommendations for action based on this structure.
Conclusion: Findings shed light on the experiences of the women by enhancing our understanding on factors contributing to BC racial disparities. It is also serving as a tool to voice involvements of women in developing effective interventions for BC diagnosis and treatment delays.
Planning of health education strategies, interventions, and programs Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Multi-academic, professional and community partnerships: An intervention model to achieve Cancer health Equity
Erika de la Riva, MA1, Aida L. Giachello, PhD2, Karriem S. Watson, DHSc, MS, MPH3, Moira Stuart, Ph.D4, Erica Martinez, MBA, MPH5, Alicia Rodriguez, MEd6, Raul Vasquez, MEd7, Juan Mosqueda, MA8, Yamile Molina, MS, MPH, PhD9, Susan Magasi, PhD6, Jorge Girotti, PhD3 and Melissa Simon, MD, MPH10
(1)Northwestern University's Feinberg School of Medicine, Chicago, IL, (2)Feinberg School of Medicine, Chicago, IL, (3)University of Illinois at Chicago, Chicago, IL, (4)Northeastern Illinois University, Chicago, IL, (5)University of Illinois Cancer Center, Chicago, IL, (6)Universtiy of Illinois at Chicago, Chicago, IL, (7)Universtiy of Illinois at Chicago, 60612, (8)Universtiy of Illinois at Chicago, 60612, IL, (9)UIC School of Public Health, Chicago, IL, (10)Northwestern University, Feinberg School of Medicine, Chicago, IL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Chicago has one of the highest cancer rates among African Americans and Hispanics/Latinos. In 2015 the NCI funded the Chicago Cancer Health Equity Collaborative (ChicagoCHEC)was established to foster meaningful cancer research, education, training and outreach. The Community Engagement Core is charged with establishing programs and processes that promote robust relationships between this partnership and Chicago communities in order to promote cancer health equity.
Methods: Participatory action research and empowerment approaches have been used to establish a solid foundation between the academic institutions and the diverse professional and community organizations including faith-based, cancer advocacy, public health, government, public schools, media and cancer survivors in the planning, development and implementation of research, training and outreach activities. Coalition effectiveness evaluation tools were developed to assess the strength of the partnership.
Results: This partnership is driven by a CSC composed of 22 community and professional partners who have been involved in key activities including the partnership's public announcement/community press conference, review of pilot and partnership grants, selection of summer research fellows, participation in community need assessments and in planning of the first annual cancer research symposium.
Conclusion: Building community, professional and academic partnerships has proven to be the most effective way in sharing institutional and community resources and integrating culture and community's expertise to address cancer health equity and to train a future team of cancer researchers. Key in this process was the establishment of an infrastructure that called for a strong administrative and management component, leadership, on-going communication, and meaningful participation.
Administer health education strategies, interventions and programs Administration, management, leadership Assessment of individual and community needs for health education Diversity and culture Public health or related education Public health or related research
Abstract
University of Guam/University of Hawaii Cancer Center Partnership: A capacity building model to address cancer health equity through research, outreach and training
Hali Robinett, MPH1, Neal Palafox, MD, MPH1, Carl-Wilhelm Vogel, MD, PhD1, David Ward, PhD1, Rachael Leon Guerrero, PhD, RDN2, John Peterson, PhD3 and Robert Underwood, EdD3
(1)University of Hawaii Cancer Center, Honolulu, HI, (2)University of Guam, Mangilao, Guam, (3)University of Guam, Mangilao
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
With some of the highest cancer rates in the world, Pacific Islanders (PI) in Guam, Hawaii, and the U.S. Associated Pacific Islands (USAPI) experience greater cancer health disparities than majority populations in Guam, Hawaii and the U.S. continent. Multiple socio-cultural and economic barriers to health care access result in late state diagnosis, poor survival outcomes and high health care costs. The UOG/UHCC Partnership aims to build capacity to reduce cancer health disparities and advance health equity among PI in GU/HI/USAPI through cancer research, training, and outreach. Funded since 2003, the Partnership supports research of regional relevance and global importance; a portfolio of over 15 research projects focus on breast and cervical cancer and unique cancer risks, importantly betel nut use. Since 2009, 68 publications, 89 abstracts, and 9 grant awards have resulted from the Partnership. Because PI are highly underrepresented in the biomedical research community, our education program has trained 22 graduate students. Mentorship, career development and research fellowships are also provided to faculty, early stage investigators, graduate students and postdocs at UOG/UHCC. Community-based participatory approaches have engaged youth in projects to reduce tobacco use, leading to landmark tobacco control legislation in Guam. Current outreach efforts aim to increase cervical cancer screening in the islands. Unique multi-ethnic, sociocultural, and geographic characteristics of the Partnership provide for many unique and important cancer research, training, and outreach opportunities of regional and global importance. Our regional research infrastructure serves as a model for research collaboration and capacity building to advance cancer health equity.
Diversity and culture Public health or related research Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Living Location Relationship to Cancer Cases Diagnosed in a Large Urban Hospital in La Paz, Bolivia
Stephen Allegra, B.S.1, Adam Kravietz1, Philip Kittelson, MD2 and Alberto Caban-Martinez, DO, PhD, MPH3
(1)University of Miami Miller School of Medicine, Miami, FL, (2)Legion Verde, La Paz, Bolivia (Plurinational State of), (3)University of Miami, Miller School of Medicine, Miami, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction:
Early screening and diagnosis of cancer frequently varies by geographic region and access to healthcare, which in turn influences cancer staging and prognosis. In Bolivia, malignant tumors are often diagnosed during the last stages of disease because of patients' inability to access healthcare and pay for their treatments. In the present study, we examine the relationship of living location to cancer diagnosis in a sample of patients treated in a large urban hospital in La Paz, Bolivia (Hospital de Clínicas).
Methods:
We performed a retrospective chart review study of all consecutive admissions on the oncology ward from January 1, 2015 to June 31, 2015. We used data collected by our research team from the hospital's statistics department linked with unique cancer surveillance records. Descriptive analyses of select living location, gender, age, employment, occupation, and cancer diagnosis variables from all records were tabulated.
Results:
Study participants' (n=753) ages ranged from 15 to 93 years (mean ± standard deviation; 53.3±15.1) with a gender distribution of 19.1% male and 80.1% female. La Paz, a relatively older geographic city had participants with a higher proportion of urinary (1.3% vs. 0.0%) and head & neck (2.3% vs. 0.3%) cancers while El Alto, a newer, low-resource city, had higher endocrine cancers (6.1% vs. 3.1%). Among employed participants, service and white-collar workers represented a greater proportion of cancer cases.
Conclusions:
Despite the lack of a national cancer registry, hospital records can provide opportunities for both oversight of high-risk populations and capacity building of surveillance efforts.
Conduct evaluation related to programs, research, and other areas of practice Epidemiology Occupational health and safety
Abstract
ISS Stage, Molecular Risk and Geographic Distance from the Site of Care Impacts Outcome in Newly Diagnosed Multiple Myeloma
Scott Miller, Ph.D.1, Christoph Heuck, M.D.1, Frits van Rhee, M.D., Ph.D.1, Bart Barlogie, M.D., Ph.D.1, Gareth Morgan, M.D., Ph.D.2 and Niels Weinhold, PhD2
(1)University of Arkansas for Medical Sciences / Myeloma Institute, Little Rock, AR, (2)University of Arkansas / Myeloma Institute, Little Rock, AR
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
background: Multiple Myeloma (MM) is a plasma cell malignancy that can result in renal dysfunction, bone destruction, and bone marrow failure. The International Staging System (ISS) and Gene Expression Profiling (GEP70) provide important prognostic information. Patient distance traveled for MM treatment is not considered in prognostication or risk stratification.
methods: The Total Therapy 3 (TT3) protocol for newly diagnosed MM at the Myeloma Institute (MI) at the University of Arkansas for Medical Sciences prospectively enrolled 480 participants between February 2004-July 2006. TT3 utilized VTD-PACE induction chemotherapy followed by autologous stem cell transplantation and multi-year, multi-drug maintenance therapy. A Cox PH model was utilized to retrospectively analyze time to progression (PFS) and death (OS). Participants residing <120 miles from MI were defined as ‘in close proximity' (CP), those residing ≥ 121 miles were defined as ‘not in close proximity' (NCP).
results: 469 participants had baseline ISS and GEP70 information available. Median follow up was nearly 9 years at analysis. CP to MI (n=70) was associated with shorter PFS (HR 1.67, 95% CI [1.17 - 2.38]), p = .004 and shorter OS (HR 1.67, 95% CI [1.17 - 2.39]), p = .004 compared to NCP (n=399) after controlling for GEP70 risk and ISS Stage. There were no significant differences in outcomes based on protocol compliance, race or gender.
conclusion: CP was associated with shorter PFS and OS. Known modifiers of risk did not explain the difference in outcomes. This finding should be confirmed in a larger data set and SES factors should be evaluated.
Basic medical science applied in public health Clinical medicine applied in public health Public health or related research
Abstract
Experience of Low-Income Men with Prostate Cancer under the Patient Protection and Affordable Care Act (ACA)
Grecia B. Vargas, MSPH1, Sarah E. Connor, MPH, CHES2, Lorna Kwan, MPH3, Sima Nassiri1, Sally L. Maliski, RN, PhD, FAAN4, Ying-Ying Meng, DrPH5, Arlene Fink, PhD6 and Mark S. Litwin, MD, MPH1
(1)David Geffen School of Medicine at UCLA, Los Angeles, CA, (2)UCLA, Los Angeles, CA, (3)David Geffin School of Medicine at UCLA, Los Angeles, CA, (4)University of Kansas Medical Center School of Nursing, Kansas City, KS, (5)UCLA Center for Health Policy Research, Los Angeles, CA, (6)David Geffen School of Medicine at UCLA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
With prostate cancer projected to remain the most frequently diagnosed non-skin cancer among men in the United States for 2016, access to healthcare coverage resulting from the Patient Protection and Affordable Care Act (ACA) represents a highly significant gain to the prostate cancer community. For example, in 2014 the ACA allowed California to expand full-scope Medicaid benefits to a portion of the previously under- and uninsured population. As a result, IMPACT (a California state-funded program that provides free prostate cancer treatment and nurse case management to low-income, uninsured men) saw a large number of its participants transition into full-scope healthcare insurance coverage. The majority of ACA-subsidized care research carried out to date has not yet extended to urologic (and therefore, prostate) cancer. To understand how the ACA is affecting care and health outcomes, we are following a cohort of 45 low-income men with prostate cancer through their transition from IMPACT to new healthcare insurance plans by conducting a series of semi-structured in-depth interviews over a 1-year period. We are presenting preliminary results from our study. Qualitative data analyses based on grounded theory have already begun to provide insight into how patients navigate the system and are revealing specific barriers affecting patients' ability to receive adequate cancer care. Among these barriers are low health insurance literacy and inappropriate emergency room visits. Providers and policymakers concerned with low-income prostate cancer care should consider methods for insuring low-income men, ideally featuring additional assistance regarding how best to make use of the healthcare system.
Advocacy for health and health education Chronic disease management and prevention Diversity and culture Planning of health education strategies, interventions, and programs Public health or related laws, regulations, standards, or guidelines Public health or related research
Abstract
Racial/Ethic Disparities in the Receipt of Definitive Treatment for Prostate Cancer: Does Cancer Severity Matter
Kelvin Moses, MD, PHD1, Heather Orom, PhD2, Alicia Brasel, MPH, Jacquelyne Gaddy, MPH and Willie Underwood III, MD, MS, MPH4
(1)Vanderbilt University Medical School, Nashville, TN, (2)University at Buffalo, Buffalo, NY, (3)Roswell Park Cancer Institute, Buffalo, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
African American men (AAM) compared to White men (WM) are one half time more likely to be diagnosed with and are twice as likely to die from PCa. Racial/ethnic PCa treatment variations may represent a significant source of disparity in survival outcome. The objective was to evaluate racial/ethnic variations in the receipt of definitive therapy stratified by disease severity.
The Surveillance, Epidemiology and End Results (SEER) database was used to identified men diagnosed with PCa from 2004-2011. Logistic regression analyses were performed to determine the association of receipt of definitive PCa treatment by race/ethnicity and risk of PCa progression/death.
Results: The study cohort included 327,641 men with clinically localized PCa. Compared to WM, AAM had lower odds of receiving definitive treatment among low (OR 0.83; 95% CI: 0.79,0.87), intermediate (OR 0.73; 95% CI: 0.70,0.76), and high risk men (OR 0.58; 95% CI: 0.55,0.62; all p<0.001). Compared to WM, Hispanic men among men with low risk disease had higher odds (1.10; 95% CI:1.04, 1.16, p=.001) and among men with intermediate and high risk disease had lower odds (OR 0.90; 95% CI: 0.86,0.95, p=0.001 and OR 0.78; 95% CI: 0.72,0.84, p< 0.001, respectively) of receiving definitive treatment.
Conclusions: AAM and Hispanic men demonstrate a clear disparity in the receipt of PCa definitive therapy, compared to WM. The disparity in the receipt of definitive treatment is greatest among men with higher risk disease. If PCa treatment, especially among high risk men, has survival benefits, then racial treatment disparities must be eliminated.
Clinical medicine applied in public health Social and behavioral sciences
Abstract
African American Cancer Survivors Report Better Communication with their Health Care Providers than Caucasian Survivors: An Analysis of Two National Databases
Monita Karmakar, M.S. , Ph.D. student1, Timothy Jordan, M.Ed., Ph.D1, Amy Thompson, Ph.D., CHES1, Jiunn-Jye Sheu, PhD, MSPH, MCHES1 and Iman Mohamed, MD2
(1)University of Toledo, Toledo, OH, (2)The University of Toledo Medical Center, Toledo, OH
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Communication between cancer survivors and healthcare providers is an important component of treatment and survivorship.
Purpose: To assess cancer survivors' communication with their health care providers and to determine if there were differences by race.
Method: Data from 2010 NHIS (N = 2,333) and 2011 MEPS (N = 1476) databases were analyzed. Survivors were asked if their health care providers discussed various survivorship topics (e.g., psychosocial needs, recommended lifestyle behaviors, required follow up tests). Bivariate and Multivariate Regressions were used for the analysis.
Results: Less than a 1/3 (NHIS) reported that their doctors talked to them about the emotional impact of cancer; African Americans were more likely than Whites to speak to their doctors about this topic [OR: 2.79, CI:(2.10-3.70)]. Of those who did not have this conversation, 26% indicated they would have liked to. 68% (NHIS) said that they received advice about cancer checkups after active treatment. However, there were no significant differences by race [OR: 0.67, CI:(0.71-1.31)]. In comparison, 54% of survivors (MEPS) reported discussing psychosocial needs; 68% discussed lifestyle behaviors; 68% discussed treatment side-effects; and 86% discussed required follow up tests. African Americans (MEPS) were more likely than Whites to discuss at a greater detail psychosocial needs [OR: 2.40, CI:(1.69-3.39)]; lifestyle modifications [OR: 2.19, CI:(1.53-3.13)]; treatment side-effects [OR: 2.20, CI:(1.52-3.19)]; and required follow up tests [OR: 1.93, CI:(1.26-2.96)] with their doctors.
Conclusion: Contrary to past research studies, African American cancer survivors in the NHIS and MEPS reported better communication with their health care providers than Whites.
Clinical medicine applied in public health Social and behavioral sciences
Abstract
African American Cancer Survivors Are More Likely than Caucasian Survivors to Receive a Survivorship Care Plan and Treatment Summary: An Analysis of a National Database
Monita Karmakar, M.S. , Ph.D. student, Timothy Jordan, M.Ed., Ph.D and Amy Thompson, Ph.D., CHES
University of Toledo, Toledo, OH
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: National cancer survivorship guidelines recommend that survivors should receive a treatment summary and survivorship care plan after completing active treatment.
Purpose: To determine the proportion of cancer survivors who received a treatment summary and survivorship care plan and to determine if there were differences by race and cancer type.
Method: Data from the 2010 National Health Interview Survey (N = 2,333) were analyzed. Survivors were asked if they received a survivorship care plan and a treatment summary after active treatment. The survivors were also queried about their quality of life, mental health, and physical health status. Bivariate and Multivariate Regressions were used to analyze the data.
Results: Less than 1 in 3 survivors (32%) reported receiving a treatment summary while 62% reported receiving a document that contained details about routine cancer checkups post treatment. African Americans were more likely than Caucasians to receive both the treatment summary [OR: 2.09, CI: (1.53-2.85)] and the document regarding routine checkups [OR: 1.76, CI: (1.19-2.60)]. Bivariate analysis showed that quality of life did not vary by the receipt of either type of document. Variations in the receipt of the documents by cancer type were also observed.
Conclusion: Contrary to other published research studies regarding the differences in the quality of survivorship care by race, the NHIS (2010) data indicates that African American cancer survivors received better quality care than Caucasian survivors.
Clinical medicine applied in public health Social and behavioral sciences
Abstract
Race, Ethnicity, Socioeconomic Status, Treatment, and Survival Time among Pancreatic Cancer Cases in Florida
Yuemeng Li, BSc, MSPH1, Jill Steinmetz, BSc, MSc (c)2, Aliyah Gauri, BSc, MSPH1, Lanyu Zhang, BM, MS3, Daniel Sussman, MD, MSPH1 and Tulay Koru-Sengul, PhD, MHS1
(1)University of Miami Miller School of Medicine, Miami, FL, (2)University of Miami, Miller School of Medicine, Miami, FL, (3)University of Miami, Miller School of Medicine, Palmetto Bay, FL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Pancreatic cancer reveal outcome disparities across race, ethnicity, treatment, and neighborhood poverty status (NPS). We report socio-demographic and survival disparities considering the four main factors together.
Methods: Pancreatic cancer patients in Florida Cancer Data System (1981-2013) registry is linked with 2000 US Census to explore 1-year survival rates and median survival. Disparities in race, ethnicity, treatment, and NPS are assessed with Kaplan-Meier method and survival curves. Cox proportional regression was used to model overall survival (OS). Adjusted hazard ratio (AHR) with 95% confidence interval (95%CI) were calculated.
Results: Of 45,295 pancreatic cancer patients, the majority were white (88.8%), non-Hispanic (89.7%), and of middle-low NPS. Nearly half of patients receive no treatment compared to one (34%), two (12%), and three (5%) types of treatment. The median survival for all patients were 4.1 months (95%CI:4.0-4.1). For 1-year OS, all patients had a rate 19.8% compared to 9.1% (no treatment), 23.7% (one), 34.8% (two), and 59% (three) and 17.5% in blacks vs. 20.1% in whites, 19.5% in non-Hispanic vs. 22.3% in Hispanic, and lowest (16.7%), middle-low (18.1%), middle-high (20.6%), and highest (23.3%) NPS. In the adjusted model, number of treatment from one (0.52;0.41-0.50), two (0.42; 0.40-0.41), three (0.33;0.31-0.35) treatments compare to none were significant. Race (black vs. white:1.68;1.01-1.14), and ethnicity (Hispanic vs. non-Hispanic: 0.90;0.85-0.59) were significant predictor od OS.
Conclusions: Our results show disparities across race, ethnicity, treatment, and NPS. White, non-Hispanic, receiving more types of treatment, and better NPS had better survival after pancreatic cancer diagnosis.
Epidemiology Public health or related research