Background: Mammography use may indicate inequalities in access to imaging-based breast health services and diagnostic care in India. This study examined rural–urban differences in self-reported mammography use among women aged 45 years and older and decomposed the gap.Methods: We analyzed Wave 1 data from the Longitudinal Ageing Study in India, 2017–2018, including 35,009 women. Weighted prevalence estimates, multivariable logistic regression, and Fairlie decomposition were used.Results: Overall, 1.3% of women reported mammography use in the past two years. Use was nearly three times higher among urban than rural women, at 2.3% and 0.8%, respectively. Higher morbidity, household consumption, media exposure, and residence in some regions were associated with higher odds of mammography use, whereas widowed women and women aged 65–74 years had lower adjusted odds. Fairlie decomposition showed that observed characteristics explained 54.03% of the rural–urban gap. Education made the largest contribution, accounting for 63.18% of the explained component, followed by morbidity and media exposure.Conclusion: Mammography use among women aged 45 years and older in India is very low and unequally distributed between rural and urban areas. Improving equity requires better access to breast cancer early-detection, referral, and diagnostic services, particularly for rural and socially disadvantaged women.
Background: Previously identified sociodemographic factors associated with colorectal cancer (CRC) screening have not consistently been evaluated simultaneously and in the context of additional regional geographic factors, such as urban/rural and Appalachian residence. This study aims to evaluate these factors and adherence to 2021 U.S. Preventive Services Task Force (USPSTF) CRC screening guidelines among Ohio residents.Methods: Participants were recruited into wave 2 (conducted in 2023-2024) of the Community Initiative Towards Improving Equity and Health Status (CITIES) Study and surveyed to assess sociodemographic factors and CRC screening adherence. Multivariable logistic regression analyses were used to identify independently associated factors.Results: CRC screening adherence was independently associated with age (65 + years vs. 45–54 years, OR: 6.36, 95% CI: 3.58-11.30), income ($100,000 + vs. <$49,999, OR: 2.18, 95% CI: 1.27-3.76), health insurance coverage (yes vs. no, OR: 5.15, 95% CI: 1.77-14.92), and residence in an Appalachian (yes vs. no, OR:1.90, 95% CI: 1.13-3.20) or an urban (vs. rural) county (OR: 1.80, 95% CI: 1.11-2.92).Discussion: CRC screening adherence in Ohio is shaped by intersecting sociodemographic and geographic factors. These findings support expanding culturally tailored interventions and targeting rural and younger residents, and those with lower income to enhance CRC screening adherence.
Background:We analyzed repeated cross-sectional trends in body size and composition among US adults with a history of cancer. Methods:Data from self-reported cancer survivors aged ≥ 20 years in the Continuous National Health and Nutrition Examination Survey 1999-2006 and 2011-2018 were analyzed. Outcomes included body mass index (BMI, n = 3544) and waist circumference (WC, n = 3354). Dual-energy X-ray absorptiometry-derived indices, including fat mass index (FMI, n = 1767), lean mass index (LMI, n = 1752), and appendicular skeletal muscle mass index (ASMMI, n = 1741), were analyzed for individuals aged ≥ 20 years from 1999-2006 and aged 20-59 years from 2011-2018. Multivariable linear regressions were used to assess associations across data cycles. Results:Across 19 years, average BMI increased from 27.1 kg/m2 to 30.0 kg/m2 (p < .001) and WC increased from 96.1 cm to 103.8 cm (p < .001) among all cancer survivors. FMI, exceeding obesity cutoffs since the 2006-2007 cycle, showed no significant changes. Among individuals aged 20-59 years, an increased LMI was observed in males and an increased ASMMI was observed in males and non-Hispanic White during 2011-2018. Conclusion:Our findings highlight the need to address obesity and fat mass among cancer survivors.
ObjectiveContinued participation in yearly screening is necessary to maximize the effectiveness of lung cancer screening (LCS) with low-dose CT to detect early-stage disease. Determinants of LCS adherence are multi-faceted, rely heavily on factors related to health behavior, and need to be better understood. This exploratory study applied social-cognitive theory to characterize key demographic and clinical factors associated with LCS-specific health information processing related to annual adherence, with the goal of informing future hypothesis generation.Methods and MaterialsThis study employed a descriptive, cross-sectional survey of LCS-eligible individuals who had recently completed a low-dose CT and received results that recommended annual follow-up. Study participants completed a survey based on the Cognitive Social Health Information Processing model to describe health information processing and screening behaviors among individuals eligible for annual LCS.ResultsThe survey was completed by 143 LCS individuals with recommended annual follow-up, finding that this population has high self-efficacy about the LCS process, perceives the benefits as high, reports few barriers to continued annual screening, has low fatalism, but also reports suboptimal LCS-specific knowledge.ConclusionThese findings expand the limited literature addressing psychosocial and behavioral aspects of continued LCS participation and provide valuable information for future communication with LCS participants.
PurposeMichelle’s Place is a nonprofit cancer resource center in California, which offers patient navigation to patients with cancer. Michelle’s Place also provides education, support groups, and other activities to both clients and families. The objective of this paper is to describe activities conducted by patient navigators and to conduct a cost analysis to estimate the cost of a nonclinical patient navigation and cancer support program.MethodsWe collected salaries, time spent on various activities to support and conduct patient navigation, and costs of nonlabor activities. We separated the labor and nonlabor costs into core patient navigation activities (e.g. meeting with clients to conduct assessments; providing resources for financial assistance) and supplemental patient navigation activities (such as activities geared toward family members). We estimated labor and nonlabor costs for patient navigation, and costs per client navigated.ResultsWe calculated cost per client navigated to be $639.23. The cost per client navigated for core patient navigation activities was $463.94 and for supplemental activities was $175.29.ConclusionsOur findings provide an estimate of resources required to support a patient navigation program for patients with cancer. This study adds to the limited research on the cost of these programs in non-profit, community-based organizations.
Introduction: Lung cancer is a leading cause of cancer deaths in the U.S., with significant geographic disparities in incidence and mortality. Understanding the relationship between spatial variations and other risk factors to lung cancer mortality counts (LCMC) is critical for guiding targeted public health interventions.Objective: This study examines how spatial variations, demographic, socioeconomic, behavioral, health, and environmental risk factors are associated with LCMC in Kansas.Methods: LCMC data from 105 Kansas counties were analyzed using Poisson and Negative Binomial models incorporating Conditional Autoregressive (CAR) and Besag–York-Mollié 2 (BYM2) spatial effects models. Predictors included elderly population (%), rurality, poverty, housing, smoking, obesity, pollution, and proximity to coal power plants. Model performance was assessed using Deviance Information Criterion and the Mean Absolute Percentage Error.Results: The Poisson BYM2 model with correlated heterogeneity provided the best overall performance. In this model, the elderly population (%) and rurality were significantly and positively associated while PM2.5 showed an unexpected negative association.Conclusion: Spatial models, particularly BYM2, provide valuable insights into LCMC hotspots and risk factors. Public health strategies should focus on equity in high-risk clusters through targeted interventions and improved access to healthcare.
e13754 Background: Ensuring adequate participation of women in cancer research is a national priority. Sex contributes to differences in cancer risk, treatment response, and the risk of adverse reactions to anticancer agents. Thus, the NIH issued a policy for the Inclusion of Women and Minorities as Subjects in Clinical Research that became an important review criterion for grants. To understand this policy’s impact in cancer research, we analyzed women's participation in clinical trials at our institution over the last 10 years. Methods: In this retrospective observational study, we determined the proportion of women participating across cancer treatment clinical trials at the Abramson Cancer Center (ACC) at the University of Pennsylvania from 2012 - 2022. Deidentified data was available from > 170,000 participants in ACC human subjects research. We included those aged > = 18 with a confirmed cancer diagnosis or pre-cancerous condition and enrolled in a cancer treatment clinical trial. We excluded cancers that predominantly affect one sex. We compared women participation rates at the ACC to national sex incidence rates for each cancer and to sex incidence rates in our catchment area. Results: From 2012 – 2022, the percentage of women participating in non sex-specific cancer studies at ACC was 54% +/- 5.7% (mean +/- SD, range 43.3% to 66.0%). Among all cancers analyzed across 9 disease areas and over the ten-year period, women participation was similar to national incidence, with three exceptions: ENT and Neurologic (women participated relatively more >5%), and Thyroid (relatively less ≤5%). Compared to the percentage of women with cancer in our catchment area, women participated more in Neurologic and less for Pancreas and Thyroid. Finally, compared to the percentage of patients at the ACC, women participated less only for Liver (Table 1). Conclusions: When subdivided by cancer type, and excluding sex-specific tumors, women were neither over-represented nor under-represented in clinical trials compared to patients cared for at the ACC, in our catchment area, or nationally. Because the percentage of women varies by cancer type, women participation should not necessarily be 50%. Hence, in line with the NIH’s efforts, women at our center were well-represented in treatment clinical trials for cancer, beyond just trials for sex-specific diagnoses such as breast and gynecological cancers. Cancer Type (Grouped) National 2012-2022 (Difference) Catchment Area 2015-2019 (Difference) ACC cancer patients 2022 (Difference) ACC trial participants 2012-2022 ENT 19.9 (+5 ) 28.9 (-4) 26.1 (-1.2) 24.9 GI 45.4 (-0.1) 45.1 (+0.2) 46.3 (-1) 45.3 GU 30.2 (-0.2) 30.6 (-0.6) 31 (-1) 30.0 Liver 28.2 (-4.8) 26.8 (-3.4) 34.3 ( -10.9 ) 23.4 Lung 48.5 (+4.1) 52.6 (0.0) 52.6 (0.0) 52.6 Melanoma 41 (+4.2) 41.1 (+4.1) 43.5 (+1.7) 45.2 Neurologic 43.8 (+6.6 ) 36.2 ( +14.3 ) 50.9 (-0.5) 50.4 Pancreas 48 (-3) 50.3 ( -5.3 ) 49 (-4) 45 Thyroid 75.1 ( -9.1 ) 73.6 (-7.6 ) 69.3 (-3.3) 66
Background: Sleep disturbances impact quality of life among gynecologic cancer survivors (GCS), yet comprehensive understanding of sleep determinants remains limited.Methods: We analyzed National Health Interview Survey (2009–2018) data among GCS (N = 1,680). Sleep duration was categorized as short (< 7 h), optimal (7–9 h), or long (< 9 h). Multinomial logistic regression models examined associations with lifestyle factors, health outcomes, and social determinants of health adjusting for age, BMI, and year with optimal sleep being the reference.Results: Among GCS, 37.9% reported short sleep, 57.1% optimal sleep, and 5.0% long sleep. In the fully adjusted model, women reporting fair/poor health compared to excellent/very good/good health had higher odds of short sleep (aOR = 1.93, 95% CI: 1.38–2.71) and long sleep (aOR = 4.12, 95% CI: 2.10–8.09). Women with graduate degrees, compared to those with less than high school education (aOR = 1.87, 95% CI: 1.23–2.83) and high school graduation (aOR = 1.52, 95% CI: 1.10–2.10) had higher odds of short sleep. Uninsured women compared to insured women had lower odds of short sleep (aOR = 0.54, 95% CI: 0.34–0.84) and long sleep (aOR = 0.39, 95% CI: 0.19–0.78).Conclusions: These findings highlight the importance of addressing social determinants and health equity in sleep interventions for cancer survivors.
Background: Manufacturing industrial change and cancer survival is understudied. This investigation tested associations between manufacturing job change, health insurance, and cancer survival in the state of Ohio.Methods: Sociodemographic and malignancy data for adults diagnosed with a first, primary invasive cancer between 2008 and 2020 were from the Ohio Cancer Incidence Surveillance System. County-level manufacturing employment data were from annual Current Population Surveys. Manufacturing job change was calculated as percent change 10 years before diagnosis. Accelerated failure time models of cancer survival time were built to test interactions between manufacturing job loss and health insurance and generate time ratios and 95% confidence intervals (CI) adjusting for sociodemographic factors. Cases were right censored at death from non-cancer cause or December 31, 2020, whichever was later.Results: There were 65,013 cancer deaths over 1,284,953 person-years. 5-year cancer-specific survival was 74.5%. The association between survival time and manufacturing jobs depended on health insurance (p < 0.0001); among those with Medicaid, survival time decreased by 6% (95% CI: 3%, 9%) for each 51% loss in manufacturing jobs. Among those with Medicare, survival time increased 4% (95% CI: 0%, 9%) for such increases in jobs. Discussion: Manufacturing job loss might impact cancer survival differently by health insurance.
Background: The COVID-19 pandemic led to organizational changes in cancer care and prevention, including approaches to cancer screening outreach and navigation. Our study aimed to identify current strategies used by outreach and navigation teams to facilitate cancer screening.Methods: In this qualitative study, in-depth interviews (N = 11) were conducted using positive deviant sampling to recruit cancer screening outreach and navigation teams from healthcare organizations across New Jersey. The immersion-crystallization approach was used to assess emergent themes. Identified strategies were mapped to screening barriers.Results: Participants reported six key strategies to address cancer screening barriers: (1) Build and sustain a diverse, cohesive patient outreach and navigation team; (2) Personalize outreach to patients and local organizations; (3) Have a dedicated data analyst to identify and track patients; (4) Offer multiple screenings in one visit and a seamless transition to the next service; (5) Advertise incentives and opportunities that can address social determinants of health needs; and (6) Develop relationships and referral systems with local specialists and residency programs.Discussion: Cancer screening strategies have evolved through the pandemic, becoming more attuned to the patient experience. Healthcare organizations should consider investments in centralized cancer navigation and outreach and data-related infrastructure.
Background:The Colorectal Cancer Control Program (CRCCP) funds recipients to partner with primary care clinics to adopt and sustain evidence-based interventions (EBIs) that increase CRC screening. This qualitative study explored how CRCCP recipients support their clinic partners to sustain EBI implementation. Materials and methods:Two waves of data collection - including 27 key informant interviews and 4 validation focus groups with CRCCP recipients - explored recipients' preparation for partnering with potential clinics and supporting EBI implementation and sustainment. Thematic analysis identified support strategies used throughout the CRCCP lifespan. Result:To prepare for partnerships with clinics, recipients assessed organizational characteristics (leadership support, staffing, and data capacity) to determine readiness for implementing and sustaining EBIs. Recipients then: provided funding for implementation support, and ongoing training and technical assistance; established a clinic-level screening champion; and integrated EBIs into clinic workflows. Some recipients continue to partner with clinics after EBIs are sustained to monitor CRC screening rates and fund follow-up colonoscopies. Discussion:Study findings indicate that assessing organizational characteristics to determine readiness and providing funding and ongoing technical assistance are practical approaches to support CRC EBI sustainment. Results can inform program and partnership planning among CRCCP recipients and other cancer screening and chronic disease prevention programs.
Introduction: We identified potential approaches to address barriers to colorectal cancer (CRC) screening in rural communities of award recipients from the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program (CRCCP).Methods: Nine program managers and directors discussed approaches to address barriers to CRC screening. The programs served areas with rural communities and tribal reservations. Participants participated in five monthly web-based meetings and completed questionnaires regarding the use and usefulness of approaches. We conducted two focus groups with award recipients’ partners to validate the approaches.Results: Participants indicated that patient reminders, small media, and translated materials were useful in increasing uptake. There were six approaches that all programs used and agreed were useful for providers, including creating standard operating procedures and promoting stool-based testing. There was more variation on usefulness at the health system level, but all programs used and agreed standing orders for stool-based tests were useful.Discussion: Through discussions, questionnaires, and focus groups with participants, we found that many of the approaches to overcoming barriers in rural areas focused on aiding patients in accessing screening and automating procedures to mitigate the impacts of staff and provider turnover. Further evaluation can determine effective, sustainable and cost-effective approaches.
Objective:Dental clinic oropharyngeal human papillomavirus (HPV) patient education remains understudied. Using a descriptive analysis approach, this study aimed to understand Appalachian Ohio dental clinics' provider knowledge on HPV, structural compositions for education, patient education approaches, and demographics. Methods:Surveyed Appalachian Ohio general and pediatric dentists responded to HPV education attitude statements and estimated their HPV vaccine recommendation frequency. Staff completed environmental scans about staff composition, structural capacity for general education, and HPV educational efforts and materials. Descriptive analyses were compared by clinic type. Results:All dentists (n=14) believed patients were at-risk for HPV-related cancers and most (≥64%) agreed that the HPV vaccine was safe and effective. Most felt unprepared to educate patients on HPV (64%) and few frequently recommended the HPV vaccine (14%). No clinic shared materials with patients despite most having sufficient display space (75% for ≥2 material types). Older dentist clinics were more actively engaged in HPV education, made more vaccine recommendations, and had more capacity for additional education; younger dentist clinics had more personnel that were more confident in their communication skills and the HPV vaccine. Conclusions:Appalachian dentists rarely educated patients about the HPV. Targeted educational materials and training are needed to support these providers in providing this vital information.
Background Health disparities exist in all aspects of cancer care, and Black patients continue to have the highest cancer mortality. Given major advancements in the treatment of hematologic malignancies, we evaluated whether disparities worsened in hematologic malignancies with longer relative survival rates (RSR) among Black patients compared to White patients.Methods We used Surveillance, Epidemiology, and End Results Program registries to calculate RSR for Black and White patients diagnosed with 16 hematologic malignancies from 2009 to 2019. Overall survival was estimated using method of Kaplan-Meier. Fine-Gray model associated patient and disease characteristics with cancer-specific mortality. Multivariable models determined if racial disparities varied across RSR and over time.Results Among 329,008 patients, Black patients had lower median overall survival (90 months versus 99 months) and 5-year RSR (66.6% versus 69.6%), and higher cumulative incidence rate of cancer-specific mortality, with increasingly larger interracial gap at later time points. Black patients had higher risk of death for all hematologic malignancies included, and the disparity widened as RSR improved. Over time, the negative association between race and cancer-specific mortality decreased.Discussion Although racial disparities have improved, Black–White disparities remain prevalent in hematologic malignancies and the largest gap exists for diseases with the longest survival.
Background: Lung cancer screening (LCS) has reduced lung cancer mortality by 20%, yet uptake in the U.S. remains low, especially among underserved populations. We evaluated implementation strategies designed to reduce disparities in LCS uptake based on race, ethnicity, income, and rurality and examined trends by state Medicaid expansion status.Methods: We conducted searches in MEDLINE via PubMed, Web of Science, and Embase. We screened primary studies and extracted data with assistance from four reviewers in Covidence in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were assessed for study design, intervention type, target population, etc. and stratified by state Medicaid expansion status.Results: Our review included 37 studies encompassing patient navigation, community outreach, and decision aids. Patient navigation was prevalent in both groups of states, whereas community-based approaches were more common in Medicaid non-expansion states. Most interventions showed some improvement in uptake of LCS, though the degree of impact varied across studies.Conclusion: This review demonstrates the nuanced landscape of effectiveness and challenges with addressing LCS disparities. A wide range of strategies showed some effectiveness and barriers to uptake varied depending on context, underlining the need for tailored strategies.
Background:Health insurance education could mitigate financial toxicity experienced by young adult (YA) cancer survivors by increasing confidence when navigating cancer care costs. This paper describes the protocol in a randomized controlled trial (RCT) to test a virtual patient navigation program designed to help YA cancer survivors understand their health insurance. Methods:This is a two-arm, multi-site (Huntsman Cancer Institute, Intermountain Health) RCT wherein intervention participants receive four sessions with a patient navigator (PN) and a booklet on insurance; usual care receives the booklet. We will enroll 300 YA cancer survivors (n=200 intervention; n=100 usual care) diagnosed with breast, testicular, lymphoma, sarcoma, colorectal, melanoma, or thyroid cancer between the ages of 26 and 39, who have completed treatment in the past two years. All participants will complete three surveys: enrollment, 6 months, and 12 months; medical records/insurance claims data will be collected out to 18-month follow-up. Recruitment began in the fall of 2023 and is expected to last approximately 2.5 years. The primary efficacy outcomes include improvement in health insurance literacy and financial toxicity at 6 months. Secondary outcomes include adherence to cancer surveillance guidelines at 18 months. We will also conduct cost-effectiveness and budget impact analyses. Discussion:Anticipated results from this trial could identify key information that YA cancer survivors need to improve health insurance literacy and survivorship care.
This study investigates the awareness of HPV as a risk factor for oropharyngeal cancer among US adults using data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) 5 Cycle 4. Among 2231 surveyed adults, only 29.5% were aware of the causal relationship between HPV and oropharyngeal cancer. Over one-fourth of respondents held the belief that cancer is not preventable. Factors associated with lower awareness included Hispanic ethnicity and the belief that cancer is not preventable, while higher education was associated with increased awareness. These findings underscore the critical need for population-level educational interventions to increase the awareness of HPV, its association with cancer, and the preventability of HPV-associated cancers through HPV vaccination.
Background: NCI-Designated Cancer Centers must identify their catchment areas and address cancer burden through research and community engagement, highlighting the role of catchment area data experts. Few studies evaluate roles, needs, and opportunities for catchment analytics in cancer centers. This manuscript examines survey responses about catchment area data analytics administered at the inaugural Catchment Area Data Conference.Methods: A Catchment Area Data Assessment Survey gathered insights from conference attendees. The 17-question survey aimed to describe current responsibilities and opportunities in catchment area data, including staffing, data acquisition, and analysis.Results: Two-thirds (66%) of respondents reported no specific department housed catchment area data analytics in their respective cancer center, 31% cited resource constraints as a frequent challenge, and there were disagreements on the adequacy of staff for catchment area analytics.Discussion Funding and budget of Community Outreach and Engagement (COE) offices are influenced by the need for catchment area analytics, including data, personnel, and technology. However, in our sample, COE departments are not where catchment area data are primarily housed. It was evident that, despite varied organizational structures, staffing adequacy, and resource allocation, there is a need for improved communication and understanding between responsible parties involved in catchment area analytics.
Background: This paper introduces an innovative application of precision public health by the Sylvester Comprehensive Cancer Center (SCCC), utilizing catchment area data and geospatial analytics to identify cancer hot spots with underserved populations to recruit participants into research projects on prostate cancer, H. pylori infection, and oral cancers via community outreach and engagement.Methods: Using data from SCAN360 (i.e. a web-based data repository operated by SCCC), we carried out geospatial hot spot analyses to identify statistically significant clusters of census tracts with high incidences of prostate, gastric cancer associated with H. pylori infection, and oral cancer. The hot spots were overlaid on census tracts categorized with Social Determinants of Health (SDOH) to identify recruitment targets.Results: Hot spots for prostate and gastric cancers generally overlap and cluster in communities of significant SDOH disparities and behavioral risk prevalence, especially for gastric cancer. Hot spot clusters of prostate and gastric cancer also overlap in the persistent poverty area in the catchment area.Conclusions: Geospatial analytics of catchment area data can be used to produce metrics that precisely target neighborhoods with high cancer risk and health disparities to recruit research participants. The same precision approach can also be applied for cancer screening purposes.
Background: Community cancer centers face challenges in accessing cancer data and communicating health information to patients and community members due to limited tools and resources. The CancerClarity app, recognized at the 2023 Catchment Area Data Conference Hackathon, addresses this need by integrating data visualization with Artificial intelligence (AI)-driven narrative generation. Converting quantitative cancer statistics to narrative descriptions using large language models (LLMs) may help cancer centers communicate complex cancer data more effectively to diverse stakeholders.Methods: The CancerClarity app employs LLM prompting within the R Shiny web framework, sourcing data from Cancer InFocus. It offers users an interactive exploration of cancer incidence, mortality, and health determinants across U.S. counties.Results: The CancerClarity app integrates LLM via its application programming interface (API) for real-time, linguistically tailored narratives, making cancer data accessible to a broad audience. The app offers cancer centers a cost-effective solution to swiftly identify their catchment areas and assess the cancer burden within the populations they serve.Discussion: By enhancing public health decision-making through AI-driven narratives, the app underscores the critical role of effective communication in public health. Future enhancements include the integration of Retrieval Augmented Generation (RAG) for improved AI responses and evidence-based public health guidance.
