scholarly journals Psychosocial concerns and needs of cancer survivors treated at a comprehensive cancer center and a community safety net hospital

2016 ◽  
Vol 25 (3) ◽  
pp. 895-904 ◽  
Author(s):  
Rebecca Selove ◽  
Maya Foster ◽  
Debra Wujcik ◽  
Maureen Sanderson ◽  
Pamela C. Hull ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Safety Net ◽  
Community Safety ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Psychosocial Concerns ◽  
Safety Net Hospital

ENRICH: Validating a multidimensional patient-reported financial toxicity measure.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 153-153
Author(s):  
Grace L. Smith ◽  
Robert Joseph Volk ◽  
Lisa M Lowenstein ◽  
Susan K. Peterson ◽  
Alyssa G. Rieber ◽  
...  
Keyword(s):  
Financial Stability ◽  
Safety Net ◽  
Patient Reported Outcome ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Financial Toxicity ◽  
Socioeconomically Disadvantaged ◽  
Safety Net Hospital ◽  
Patient Reported ◽  
Future Utility

153 Background: Financial toxicity is a patient-reported outcome reflecting burdens of cancer treatment costs. There is a need to assess financial toxicity in cancer care, as its unique domains—upstream factors like direct medical costs or downstream economic impact like bankruptcy—predict worse QOL, adherence, and mortality. Socioeconomically disadvantaged patients bear disparate financial toxicity burdens. We thus developed and report performance of a new measure, the Economic StraiN and Resilience in Cancer (ENRICh), to assess all financial toxicity domains in economically diverse patients. Methods: We studied 238 patients with Stage I-IV cancer from a tertiary academic comprehensive cancer center (MDA) and county safety-net hospital serving socioeconomically disadvantaged patients (LBJ). Financial toxicity domains and corresponding subscales were developed from qualitative/cognitive (n = 104) interviews. ENRICh and Comprehensive Score for Financial Toxicity (COST) questions were administered (n = 127; MDA = 71, LBJ = 56). To demonstrate known-group validity, we compared ENRICh scores between centers; for concurrent validity, we correlated ENRICh and COST; for reliability, we calculated Cronbach's coefficient α for ENRICh subscales (range 0, none, to 10, high burden). Results: There were 4 distinct, valid financial toxicity domains/subscales: 1) Burden of cost; 2) Disruption of financial stability; 3) Depletion of financial coping; 4) Depletion of instrumental coping. Patients from the 2 centers significantly differed in subscale and overall ENRICh scores. Socioeconomically disadvantaged patients had worse mean scores (4.9 vs 2.1, 95%CI -3.6,-2.1, effect size 1.4, P < .001). ENRICh significantly correlated with COST (r = -0.82, 95%CI -0.87,-0.77, P < .001). Subscales were reliable with excellent internal consistency (Cronbach α = 0.78 to 0.94). The 4 ENRICh domains collectively had synergistic impact on overall financial toxicity burden. Conclusions: ENRICh is valid, reliable, and identifies and 4 novel domains of financial toxicity. Future utility of this tool is to guide assessment/interventions targeting financial toxicity domains affecting diverse cancer patients, to mitigate disparities.

scholarly journals A culturally specific dietary plan to manage weight gain among African American breast cancer survivors

2012 ◽  
Vol 21 (2) ◽  
pp. 97-105 ◽  
Author(s):  
Kathleen A Griffith ◽  
Renee Royak-Schaler ◽  
Kim Nesbitt ◽  
Min Zhan ◽  
Adriane Kozlovsky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Vegetable Intake ◽  
Survival Rates ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Daily Consumption ◽  
Culturally Specific ◽  
Fat Consumption

Breast cancer survival rates are lower in African Americans (AAs) than in Caucasians, owing in part to a higher prevalence of obesity in the former, which increases the risk of recurrence and mortality. The Women’s Intervention Nutrition Study (WINS) found that Caucasian women who followed a low-fat eating plan experienced a lower rate of cancer recurrence than women who maintained their usual diets. The purpose of this study was to test the feasibility of a WINS plan tailored to the cultural needs of AA breast cancer survivors. This feasibility pilot study was conducted at a university National Cancer Institute-designated comprehensive cancer center outpatient clinic with AA breast cancer survivors. The culturally specific WINS (WINS-c) plan included eight individual counseling sessions, five educational group meetings, and follow-up telephone calls over a 1-year period. Outcome measures included dietary fat, triglyceride, insulin and glucose levels, and fruit and vegetable intake. Participants ( n = 8) had a mean age of 61.1 years (standard error of the mean (SEM) 3.1 years) and a mean BMI of 32 kg/m2 (SEM 4.25 kg/m)2. Baseline daily fat consumption decreased from 64.6 g (range 36.8–119.6g) to 44.0 g (21.6–73.4g) at 52 weeks ( p = 0.07). Mean daily consumption of fruits and vegetables increased by 36% and 15%, respectively. Mean triglyceride levels decreased at 12 months ( p < 0.05). Sustained hyperinsulinemia was noted in most participants, including those without diabetes. Mean calcium and vitamin D consumption decreased over the 1-year study period. In AA breast cancer survivors, the WINS-c program resulted in a trend toward reduced fat consumption and may represent a sustainable approach in this population for improvement of diet quality after breast cancer.

Abstract A62: Psychosocial resources and needs of cancer survivors treated at a comprehensive cancer center or a minority-serving institution

2015 ◽  
Author(s):  
Rebecca Selove ◽  
Maya Foster ◽  
Debra Wujcik ◽  
Maureen Sanderson ◽  
Pamela C. Hull ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Psychosocial Resources

Comprehensive Analysis of Breast Cancer Survival Outcomes in a Public Safety-Net Hospital Compared with an Adjacent Academic Cancer Center

2019 ◽  
Vol 229 (4) ◽  
pp. S146-S147
Author(s):  
Kristin N. Kelly ◽  
Emily Ryon ◽  
Francis Igor B. Macedo ◽  
Dido Franceschi ◽  
Mecker Moller ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Public Safety ◽  
Cancer Survival ◽  
Safety Net ◽  
Comprehensive Analysis ◽  
Breast Cancer Survival ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Safety Net Hospital

Using practice algorithms to deliver cancer survivorship care.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19625-e19625
Author(s):  
Guadalupe R. Palos ◽  
Fran Zandstra ◽  
Ludivine Russell ◽  
Jacklyn J Flores ◽  
Yvette DeJesus ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Survivors ◽  
Psychosocial Functioning ◽  
Phase 1 ◽  
Comprehensive Cancer Center ◽  
Cancer Site ◽  
Cancer Center ◽  
Survivorship Care ◽  
Disease Specific

e19625 Background: Clinical practice algorithms provide a framework to guide providers’ practice in delivering care to long-term cancer survivors. Here we describe how algorithms were developed in a comprehensive cancer center and types of metrics used to evaluate their feasibility. Methods: Survivorship practice algorithms were based on a multidisciplinary care approach successfully used to build screening and treatment algorithms. This model consisted of four phases: development, adoption, implementation, and evaluation of algorithms. Phase 1, expert clinicians and researchers identified and agreed upon a specific cancer site. Group-consensus and literature reviews/syntheses were used to determine eligibility criteria to transition patients to survivorship care. Phase 2, reviews and approval processes were conducted by credentialing and regulatory committees to ensure adoption of the algorithms into clinical practice. Phase 3, pilot programs were conducted to implement the algorithm(s) in disease-specific survivorship clinics. Phase 4, metrics to evaluate progress included the number of algorithms and providers’ use of and adherence to the algorithms. Results: Between 09/2008 – 12/2011, nine multidisciplinary disease-specific survivorship clinics were operationalized. Thirty-seven practice algorithms were developed to provide survivorship care based on each survivor’s specific needs. The algorithms’ framework included: 1) surveillance for recurrent or new primary malignancies; 2) primary and secondary cancer prevention recommendations; 3) management of toxicities and latent treatment effects; and 4) assessment of psychosocial functioning. Conclusions: Practice algorithms provide an organized plan to deliver comprehensive and holistic care to long-term survivors. Given the projected increase in cancer survivors, further research is needed to determine how practice algorithms impact providers’ practice and survivors’ outcomes.

Perceptions of benefits and harms of alcohol consumption as predictors of alcohol cessation in adult cancer survivors.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9595-9595
Author(s):  
Geoffrey Liu ◽  
Dan Pringle ◽  
Osvaldo Espin-Garcia ◽  
Chongya Niu ◽  
Mary Mahler ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Use ◽  
Cancer Survivors ◽  
Healthy Lifestyle ◽  
Healthcare Providers ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Logistic Regression Models ◽  
Adult Cancer Survivors ◽  
Alcohol Cessation

9595 Background: Survivorship programs are being developed at many cancer centers, addressing secondary prevention and healthy lifestyle issues. We evaluated whether perceptions regarding the harms and benefits of alcohol use influenced alcohol cessation or recidivism in adult cancer survivors. Methods: 531 cancer patients of all subtypes were surveyed at a comprehensive cancer center for their alcohol habits before and after cancer diagnosis and their perception of benefits/harms for continued drinking. Multivariate logistic regression models evaluated the association of each variable with change in alcohol consumption after diagnosis adjusted for significant socio-demographic and clinico-pathological covariates. Results: Among 325 current drinkers at diagnosis, 55% quit or cut down their alcohol consumption 1 year after diagnosis, while 16% of 95 ex-drinkers at diagnosis restarted drinking at 1 year. Negative perceptions of the effects of alcohol on the individual patient were strongly associated with cessation: the adjusted odds ratio (aOR) of quitting were significant for a perceived negative effect on quality of life (aOR=2.2, p=0.006), survival (aOR=3.8, p=1.3E-5), fatigue (aOR=3.1, p=4.6E-5) or an increased chance in self-harm (aOR=2.6, p=0.01). Perceptions of how alcohol affected the average cancer patient had similar associations. While perceptions did not influence alcohol recidivism rates, receiving chemotherapy was the only variable associated with continued abstinence (aOR=5.5, p=0.007). Although only 8% of patients received alcohol cessation information from an oncologist, it had the greatest impact on cessation (aOR=6.6, p=0.006), an association not seen with other information sources or other healthcare providers. Conclusions: Perception to the negative effects of alcohol use on their health in cancer survivors strongly predicted for alcohol cessation. The oncologist had a most significant counselling role for alcohol cessation.

Psychosocial outcomes in cancer survivors treated at a comprehensive cancer center or a minority-serving institution.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20523-e20523
Author(s):  
Debra L. Friedman ◽  
Maureen Sanderson ◽  
Pamela Hull ◽  
Debra Wujcik ◽  
Dira R Ashworth ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Disparities ◽  
Cancer Survivors ◽  
Posttraumatic Growth ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cancer Health Disparities ◽  
Mean Values ◽  
Prostate Cancer Survivors ◽  
High School Degree

e20523 Background: Cancer health disparities are well described for incidence, diagnosis and treatment. Little is known about disparities among long-term survivors. Methods: At Vanderbilt-Ingram Cancer Center (VICC), an NCI-designated comprehensive cancer center and Meharry Medical College (MMC), minority serving institutional partner, we evaluated quality of life (QOL) using the FACT-G, FACT-B, FACT-L, and FACT-P; posttraumatic stress disorder (PTSD) using the PTSD Checklist (PCL); and posttraumatic growth (PTG) using the PTG Inventory (PTGI) among breast, lung or prostate cancer survivors. We used linear regression to compare the scale mean values by institution while adjusting for confounding variables. Results: Among 111 breast, 53 lung and 68 prostate cancer survivors, mean age was 62 years, 61% were female, 33% were black, 65% were married, 22% and 67% respectively had a high school degree or some college/higher education, 36% were employed and 94% were insured. MMC survivors were younger (p = 0.0005), more likely to be black (p <0.0001), less likely to be married (p < 0.0001), less educated (p<0.0001) and more likely to be uninsured (p < 0.0001). After adjusting for race, insurance status and educational level, there were no significant differences in cancer-related QOL between VICC and MMC survivors. MMC survivors did score significantly higher than VICC survivors on the PCL (33.9 vs. 28.3; p = 0.01) and the PTGI (75.9 vs. 62.5; p = 0.002). A total of 19 (8.3%) survivors met criteria for PTSD with a score of 50 or more (18.1% MMC, 3.8% VICC, p =0.003). Scores were significantly increased for MMC survivors relative to VICC survivors on all PTG subscales, especially the appreciation for life subscale (p = 0.0005). Conclusions: Cancer health disparities extend into the survivorship period. Although overall QOL did not differ, survivors treated at an underserved institution had significantly higher PTSD than those treated at a comprehensive cancer center. Underserved survivors also exhibited higher degrees of PTG. Further evaluation will identify the most significant sources of stress and resilience in order to design interventions to improve psychosocial wellbeing and decrease disparities.

Differences in breast cancer outcomes amongst Black United States-born and Caribbean-born immigrants.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1088-1088
Author(s):  
Priscila Barreto Coelho ◽  
Danielle Cerbon ◽  
Matthew Schlumbrecht ◽  
Carlos Parra ◽  
Judith Hurley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Safety Net ◽  
Cancer Center ◽  
Advanced Stage ◽  
Cancer Data ◽  
Hispanic Caribbean ◽  
Safety Net Hospital ◽  
The Usa ◽  
The Caribbean

1088 Background: The Black population in the US constitutes of 4 million immigrants, with 50% from the Caribbean. It has been shown that breast cancer is responsible for 14%-30% of cancer deaths in the Caribbean; this is up to two times higher than the USA. Methods: Retrospective cohort of 1369 self-identified Black women with breast cancer. Data was obtained from Jackson Memorial Health Systems and University of Miami Health System Tumor Registry. Individual-level data from 1132 cases was used to estimate hazard rations (HRs) of women born in the Caribbean (CB) or in the USA (USB) using Cox proportional hazards regression analysis for overall survival. Median follow-up was 115 months (interquartile range, 91.9-138.1 months) per participant. Results: Data from 622 (54.9%) USB women and 507 (45%) CB women diagnosed with breast cancer between 2006-2017. 90% (n = 1232) of the cohort is of non-Hispanic ethnicity. Caribbean immigrants from Haiti (18.3%), Jamaica (6.5%), Bahamas (3.1%), Cuba and Dominica Republic (2.8% each), Trinidad and Tobago (1%) and other nationalities from the Organization of Eastern Caribbean States were included, mean age 55.7 [95% CI, 54.7-56.8]; USB mean age 57.6 [95% CI, 56.4-58.7] (P = 0.02). Compared to USB, CB had lower BMI at diagnosis 29.6 [95% CI, 28.9-30.3] versus 30.9 [95% CI, 30.1-31.7, P = 0.015]. Compared to CB patients, USB patients had more ER- [31.4% vs 39.1 %, P = 0.018] and triple negative breast cancers [19.6% vs 27.9%, P = 0.003]. Compared to USB patients, CB presented at more advanced stage, III and IV [44.2% vs 35.2%], p = 0.016. In spite of higher advanced stage at diagnoses, CB patients had a better breast cancer overall survival [HR = 0.75; 95%CI, 0.59-0.96; P = 0.024]. Black Hispanic patients had a better overall survival [HR = 0.51; 95%CI, 0.28-0.93; p = 0.028] compared to non-Hispanic Blacks. Compared to Hispanic Caribbean, non-Hispanic Caribbean had a worse overall survival [HR = 1.98; 95%CI, 1.00-3.94; P = 0.048]. The distribution of patients treated at the private cancer center and the safety net hospital were the same, differences in outcomes observed are due to intrinsic differences. Conclusions: This is the largest analysis to date of self-identified Black breast cancer patients in the context of nativity, race, ethnic identity and overall survival with clinico-pathologic characteristics. CB immigrants diagnosed with breast cancer have a better overall survival than US born Black patients. This finding suggests that within the African diaspora in the USA, additional factors beyond race contribute to the outcomes.

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