Session
Hot Topics across the Cancer Control Continuum: Opportunities for Equity-Focused Approaches
APHA 2022 Annual Meeting and Expo
Abstract
Improving Communication between Physicians about Social Determinants of Health for Veterans with Cancer
APHA 2022 Annual Meeting and Expo
Introduction: Social Determinants of Health (SDOH) affect outcomes of patients with cancer. The Veterans’ population also suffers from social disparities. The Veterans Health Administration has created the Health Equity Action Plan to address disparities related to SDOH. This action plan has enhanced the monitoring of SDOH among Veterans in the Primary Care setting. However, suboptimal communication between Primary Care and Cancer Care services remains an issue.
Methods: Twelve in-depth interviews were conducted at a VA Medical Center in Wisconsin: six among Primary Care providers and social workers, and six among providers in General Surgery, Medical Oncology, and Radiation Oncology. Participants were asked to describe how SDOH affects care for Veterans with cancer and identify strengths and weaknesses in using the current communication channels between specialties. Interviews were audio-recorded, transcribed, and coded. Inductive analysis based on the grounded theory was used to identify key themes related to SDOH and factors that influence care for Veterans with cancer.
Results: SDOH and communication were identified as major barriers to care for Veterans with cancer. The most common SDOH affecting this population include housing instability, transportation, food insecurity, and social support. There are four major themes: challenges specific to each SDOH, added complexity to care plans, system performance, and the role of care team members. Based on the findings, two interventions are planned: creating an accessible template in the VA electronic health record to summarize SDOH needs; and the inclusion of Primary Care providers and social workers at the initial tumor board discussion for Veterans with a new diagnosis of breast or gastrointestinal cancer.
Conclusion: The VA has developed a system for identifying and intervening on SDOH in the Primary Care setting. There exists a need to transition this knowledge to the Cancer Care setting. Addressing SDOH for Veterans is necessary and can improve health outcomes as well.
Abstract
Health Care Expenditures and Resource Utilization Associated with Chronic Lymphocytic Leukemia Among Medicare Beneficiaries
APHA 2022 Annual Meeting and Expo
Objectives
To compare differences in health care expenditures and resource utilization between Medicare beneficiaries with and without chronic lymphocytic leukemia (CLL) and to identify predictors associated with each of the economic outcomes among CLL patients.
Methods
This retrospective study used the 2017-2019 Chronic Conditions Data Warehouse representing a 20% Medicare sample. We characterized healthcare expenditures and resource utilization over 360 days across cost categories and places of services among CLL cases and a propensity score-matched sample of beneficiaries without CLL. Using generalized linear models and count models, we examined predictors of expenditures and utilization and reported marginal effects as a measure of effect sizes.
Results
A total of 2,736 CLL cases and 13,571 non-CLL matched controls were identified. Compared to non-CLL controls, the annual expenditure is higher in CLL cases (CLL cases vs non-CLL controls, mean [SD]: $22,781 [$37,592] vs $13,901 [$24,725]), mainly driven by hospital outpatient cost (20% vs 17%), carrier cost (29% vs 28%), and Part D prescription drug cost (26% vs 18%). The main categories of health care resource utilization were physician evaluation/management visits (cases vs controls, mean [SD]: 21 [24] vs 16 [21]), oncologist/hematologist visits (4 [7] vs 1 [4]), and laboratory services (4 [6] vs 2 [4]). Compared to age 65-74, patients aged 85+ had lower use and cost in maintenance services (i.e., hematologist visits, hospital outpatient, and prescription drug cost) but higher use and cost in acute services (i.e., emergency department [ED]). Compared to residency in a metro area, CLL patients living in a non-metro area had fewer physician visits but higher ED visits and hospitalizations.
Conclusion
This study provides a comprehensive characterization of health care expenditures and resource utilization associated with CLL among Medicare beneficiaries. The information about drivers of cost and use can guide healthcare delivery among older adults diagnosed with CLL.
Abstract
Trust in Cancer Information and its Associations with Cervical and Breast Cancer Screening among Latina Women: A HINTS Secondary Analysis
APHA 2022 Annual Meeting and Expo
Introduction: Cancer is the leading cause of death among Hispanics. The prevalence of breast and cervical cancer screening continues to be lower among Hispanic women compared to non-Hispanic whites. In this paper, we sought to understand the associations between trust in cancer information and adherence to cancer screening among Latina women.
Materials and Methods: The data analyzed in this study was provided by the National Cancer Institute’s Health Information National Trends Survey (HINTS). We used 4 combined HINTS datasets fielded from 2012 to 2020. The primary outcomes for this analysis were participant’s adherence to cervical and breast cancer screenings, in accordance with the US Preventive Services Task Force recommendations.
Results: From the combined HINTS cycles, a total of 1,261 respondents self-identified as Hispanic or Latina, with 46% of respondents reporting as Mexican/Mexican American, 16% Puerto Rican or Cuban, and 38% reporting a different Hispanic ethnicity. The proportion of Latinas reporting a high level of trust in cancer information varied from 92% for doctors/healthcare providers to 20% for radio. In results from multivariable models, trust in cancer information varied significantly among different Latina subgroups, age groups, access to a healthcare provider, and by smoking status.
Results from multivariable Poisson regression models examining trust in cancer information and adherence to cervical and breast cancer screening yielded different results. Compared to Latina women in the 18–34-year age category, women ages 35-49 years were significantly more likely to adhere to cervical cancer screening guidelines (IRR 1.20, 95% CI 1.03-1.38). Compared to Latina women without health insurance, Latina participants that were insured were significantly more likely to adhere to cervical cancer screening guidelines (IRR 1.23, 95% CI 1.00-1.51). Latina participants who reported having a regular healthcare provider were also significantly more likely to adhere to cervical cancer screening guidelines compared to those without a regular healthcare provider (IRR 1.15, 95% 1.03-1.29). Compared to Mexican or Mexican American participants, Latina women of Cuban or Puerto Rican background were significantly more likely to adhere breast cancer screening guidelines (IRR 1.27, 95% CI 1.11-1.45). Trust in cancer information sources across all sources were not significantly associated with adherence to cervical or breast cancer screening.
Conclusion: Future strategies to improve cancer screening may need to focus on targeting these sociodemographic factors through Latino subgroup interventions focused on increasing health literacy and encouraging communication with health providers as trusted sources of cancer information.
Abstract
Needs of Black Men in Learning Prostate Cancer Scientific Discoveries: Thematic Analysis of the Minority Prostate (MiCaP) Research Digest
APHA 2022 Annual Meeting and Expo
It is important to provide Black men (BM) the most recent prostate cancer (CaP) discoveries to make informed decisions about their healthcare because BM experience the highest rate of CaP mortality and morbidity of any racial group. Using research dissemination tools (RDTs) like videos may be one effective way to share information among BM. The Minority Prostate Cancer (MiCaP) Research Digest is a scientific dissemination intervention program, comprising seven videos and print public abstracts, created to meet the educational needs of BM in the U.S. To assess the impact of the Digest, BM were randomly assigned to either the intervention (received MiCaP materials) or control group (viewed a general video). Study participants responded to a pre- and post- assessment survey. BM in the intervention group also responded to open-ended questions on what participants did not like about the video, learned, and suggestions for improvement. Of the 220 total participants, 93 were assigned to the intervention group. Responses to the open-ended questions were inductively coded and grouped into themes using ATLAS.ti. A thematic map displayed themes and sub-themes. Themes that emerged included the importance of using racially concordant scientists and community members as sources of information. Relative to content, the themes for information were CaP diagnosis, prevention, and screening. Comments included opportunities to learn more about CaP, clinical trials, and ways to connect with scientists and community advocates. Communication channel that emerged was the use of social media to share MiCaP Research Digest. RDT improvement/concern themes were video quality, video content, use of technical languages, and follow-up opportunities. For example, there were comments on preference for short, high quality videos that had good audio, graphics, and captioned dialogues. Understanding what BM want from video RDTs and producing content based on self-identified needs is valuable in addressing CaP disparities.
Abstract
Assessment of Time to Treatment Initiation of Invasive Lung Cancer: Disparity between Black Race and White Race in the Appalachian and Non-Appalachian Region of Tennessee
APHA 2022 Annual Meeting and Expo
Background: Lung cancer continues to be the number one killer among all the cancer diseases in the United States. Early treatment after diagnosis has proven to offer a favorable prognosis of 5-year survival for small, localized tumor lung cancers. This study investigates the time to treatment initiation (TTI) of invasive lung cancer (LC) disparities within and between Black and White races, considering the association with sociodemographic factors, type of health insurance coverage, stage of cancer, and surgical treatment in Tennessee (TN), USA.
Methods: This study utilizes population-based cross-sectional data of 43,239 individuals diagnosed with invasive LC obtained from the Tennessee Cancer Registry from 2005 to 2015. We conducted bivariate and multivariate statistical analysis utilizing the Pearson Chi-Square test and Cox proportional hazard model to assess the association of TTI of invasive LC with the above-stated factors. Results are based on reporting cluster bar graphs, hazard ratios (HR), confidence intervals (CI), p-values, and hazard functions.
Results: Black patients and the Appalachian TN often had a longer average time to start surgical treatment for invasive LC after diagnosis and were proportionately at higher risk of starting treatment beyond 2.7 weeks. We found Sociodemographic factors (age, race, marital status, and county of residence), type of insurance coverage, and stage of LC to be significantly associated with TTI of invasive LC after 2.7 weeks, but not sex and surgical treatment. Among Black patients, individuals aged <45 years were at the highest risk of late treatment. Among White patients, those married were at the highest of late treatment. In the general population of invasive LC in TN, patients with private health insurance had an 8% higher risk of late treatment after 2.7 weeks compared with no insurance/self-pay. Both localized and regional stage LC had decreased risk of delayed treatment compared with the distant stage. Surgical treatment did not had an influence on delayed TTI after 2.7 weeks. Taking into account all analyzed factors, Blacks were more at risk of delayed treatment than Whites.
Conclusion: We have shown the disparities in TTI of invasive LC and its associated factors. In addition, our study serves as a guide for the development of health policy intervention on lung cancer treatment as we seek to improve patients' treatment and length of survival.
Abstract
COVID-19 Infection and Hospitalization among Individuals Seeking Care at a Comprehensive Cancer Center
APHA 2022 Annual Meeting and Expo
Introduction: While COVID-19 has been reported to disrupt general medical care, little information on its impact on cancer patients has been reported. Current trends in infection and hospitalization rates among people seeking care at cancer centers require further examination.
Methods: Self-reported history of COVID-19 infection and associated hospitalization were obtained using an electronic questionnaire at Moffitt Cancer Center (MCC) between 2021 and early 2022. Patient demographic characteristics were obtained from electronic health records. Associations between patient characteristics and COVID-19 infection and hospitalization were estimated using logistic regression.
Results: Among 16,062 new patient visits at MCC between 2021 and early 2022, self-reported COVID-19 infection rate increased from 8.6% in the first half of 2021 to 17.5% in early 2022. Meanwhile the cumulative case positivity rates reported by the state of Florida was 16.8% in June 2021 and 26.3% in March 2022. Among new MCC patients, the hospitalization rates decreased from 10.6% to 3.4% in the same timeframe. Older vs. younger individuals and males vs. females (OR=0.84 [95% CI 0.76-0.92]) were less likely to report a COVID-19 infection, whereas Hispanic vs. non-Hispanic individuals were more likely to report an infection (OR=1.59 [95% CI 1.37-1.83]). Older age, male gender (OR=1.76 [95% CI 1.32-2.34]), and race other than white vs. white (OR=1.52 [95% CI 1.03-2.20]) were associated with higher odds of hospitalization due to COVID-19.
Conclusion: The infection rate of COVID-19 doubled from the first half of 2021 to early 2022 while the hospitalization rate dropped two thirds during the same period among patients at MCC. In addition to age and gender, ethnicity was associated with viral infection, whereas race was associated with hospitalization due to COVID-19. Data regarding COVID-19 infection and hospitalization collected among vulnerable population seeking cancer care can provide valuable information regarding patient risk and health equity.
Abstract
Identifying opportunities to improve health equity in cervical cancer screening with HPV self-collection: a landscape analysis
APHA 2022 Annual Meeting and Expo
Introduction: Over half of cervical cancer cases diagnosed in the US are among women who have been inadequately screened, reflecting barriers presented by socioeconomic inequity and geographic inaccessibility. An approach to overcome barriers for conventional cervical cancer screening is self-collection of samples for HPV testing. The objective of this landscape analysis is to describe recent funding of studies of self-collection for HPV with a focus on identifying potential applications in populations that experience inequity.
Methods: Publicly accessible funding databases (NIH RePORTER, NLM, PCORI, ICRP) were explored for information on grant funding between 2010-2021 for projects on HPV self-collection for cervical cancer screening. Relevant research studies were abstracted and analyzed. Studies were categorized by the population focus and primary goals of the study.
Results: Of the 53 funded grants in this area, studies focused on women from racial and ethnic minorities (13, 24.5%), who were behind on current screening recommendations (8, 15.1%), living in rural communities (7, 13.2%), living with HIV (4, 7.6%) and identify as transgender (1, 1.9%). While many of the studies were designed primarily to evaluate direct comparisons of HPV test performance of self- vs. provider-collected samples, 23 (43.4%) studies primarily sought to show improvement in participation in cervical cancer screening programs. More than half of the studies reviewed (35, 66.0%) were specifically designed to target populations that face inequity in health care access or cervical cancer outcomes, and 16 (30.2%) studies were in international settings.
Conclusions: This landscape analysis demonstrates the wide spectrum of research funding exploring HPV self-sampling as a person-centric approach to expand the access of cervical cancer prevention services, especially for those who experience inequity in health outcomes. There is evidence that this method is vital for reaching these vulnerable populations, but gaps remain in applying the findings of these studies to reduce cervical cancer burden in practice.
Abstract
Human Papillomavirus (HPV) Vaccination Rate by Gender Identity Among US Young Adults
APHA 2022 Annual Meeting and Expo
Background: While national human papillomavirus (HPV) vaccination estimates vary by sex, little is known about variation by gender identity. We sought to estimate HPV vaccination initiation and completion by gender identity among US young adults.
Methods: We used 2018-2020 Behavioral Risk Factor Surveillance System data from individuals reporting both gender identity and HPV vaccination status. Weighted, multivariable logistic regression was used to identify factors associated with vaccination initiation and completion.
Results: The 6,484 individuals included 3,300 cismales, 3,130 cisfemales, 31 transmales, and 23 transfemales. Vaccination initiation/completion were low, at 40.1% and 17.6%, respectively, and varied by gender identity: cismale=29.1%/9.6%, cisfemale=51.3%/25.8%, transmale=50.1%/5.9%, and transfemale=34.7%/13.0% (P <.0001). In weighted multivariable models, cismales were significantly less likely than cisfemales to initiate (OR:0.39; 95% CI:0.32-0.48) and complete (OR:0.29; 95% CI:0.22-0.37) vaccination, but no significant differences were observed for transmales and transfemales compared to cisfemale. Factors associated with lower initiation included: non-Hispanic Black race (OR: 0.71; 95% CI: 0.54-0.93), high school diploma (OR: 0.57; 95% CI: 0.42-0.78), rural residence (OR: 0.64; 95% CI:0.45-0.90), no insurance (OR: 0.56; 95% CI:0.43-0.74), and no regular provider (OR: 0.67; 95% CI: 0.53-0.84). Factors associated with lower completion included: non-Hispanic Black race (OR: 0.48; 95% CI: 0.34-0.67), Hispanic race (OR: 0.70; 95% CI: 0.49-0.99), married (OR: 0.76; 95% CI: 0.57-0.95), high school diploma (OR: 0.60; 95% CI: 0.42-0.85), and no regular provider (OR: 0.63; 95% CI: 0.46-0.87).
Conclusion: HPV vaccination rates in the U.S. are low across all subsamples and future HPV vaccine uptake studies should account for gender identity.
Abstract
Health-related Quality of Life of Pediatric Brain Tumor Survivors after Treatment in Jordan
APHA 2022 Annual Meeting and Expo
With emerging treatments and technological advancement, both the amount of cancer survivors and the length of survival have increased. As a result, the quality of life among childhood cancer survivors warrants extensive attention. Health-related quality of life (HRQOL) has been studied in high-income countries (HICs) but not in low-and-middle-income countries (LMICs). Therefore, this study explored the HRQOL of childhood central nervous system (CNS) cancer survivors and its associated determinants in Jordan. 80 study participants diagnosed with CNS tumors between 2007-2016 at King Hussein Cancer Center in Jordan were recruited to respond to the PedsQL questionnaire. We analyzed their medical records and their questionnaire responses using multivariable linear OLS (ordinary least squares) regression models.
Our study found that childhood cancer survivors self-reported better HRQOL than their parents reported in the cognitive and work sub-scales but that there was no significant difference in the physical, emotional, and social sub-scales and the total PedsQL scores. Nonetheless, this study reveals that HRQOL scores reported by the child and those reported their parents are positively correlated in all domains. Factors including recurrence of tumors, supratentorial tumor location, and were identified to predict higher HRQOL scores in different sub-scales or the total PedsQL score, indicating worse quality of life. Meanwhile, we found that male gender, diagnosis of hypopituitairsm, radiotherapy and treatment were associated with better quality of life reported by the child. Significant predictors of HRQOL reported by the parents were different than those reported by the childhood cancer survivors. We note that there is an imminent need for further research regarding the HRQOL to foster evidence-based follow-up programs that support CNS tumor survivors. This study adds to the literature as one of few that explores health-related quality of life among childhood CNS tumor survivors in Jordan.
Abstract
Evaluating the Association of Cervical Cancer Screening Rates with Limited English Proficiency Populations and Community Health Center Costs in California
APHA 2022 Annual Meeting and Expo
The poorer outcomes of Limited English Proficiency (LEP) patients is well-documented in the literature and include less access to preventative care such as cervical cancer screenings. Annual cervical cancer screening rates and LEP population frequencies were evaluated using the Health Resources and Services Administration (HRSA) public database for California Community Health Centers to determine if an association existed amongst health centers which had lowest and highest quartiles in cervical cancer screenings in the LEP patient populations. Data was used for the year 2019, to limit confounders presented during pandemic years 2020 and 2021. Center resource specific covariates were also evaluated to determine how these were linked to either cervical cancer screening rates and how they may be associated with providing support to LEP patients. These included spendings per patient, overall costs, and number of patients seen. In total, 175 California CHCs were included in the study. Cervical cancer screening and LEP rates were converted into categorical variables according to 25th, 50th, and 75th quartiles. Chi-square was performed to compare lowest and highest quartiles across both independent variables when using a two-by-two contingency table. CHCs with highest costs had highest cervical cancer screening rates at P-value <0.01, independent of LEP status. Comparisons of spendings per patient and cervical cancer screenings found no significant association, with p-value >0.05; therefore, spending more per patient did not correlate with improved cervical cancer screening rates. Highest quartiles of cervical cancer screenings correlated with high LEP population proportions, and high minority percentages (highest for Hispanic). Results are indicative for the need to better capture unique needs of both non-LEP and LEP populations in CHCs using center-specific cost-effective methods, including the use of virtual health literacy-focused efforts such as the PCORI-funded “Decreasing Overtesting but On time (DOTS-O) cervical cancer patient education tool.