Interventions to reduce racial and ethnic disparities in colorectal cancer care: A systematic review.

e16509 Background: Disparities in colorectal cancer (CRC) outcomes among underrepresented racial and ethnic minority patients continue to widen. We performed, and present here, the results of a systematic review of the literature evaluating interventions to reduce racial and ethnic disparities in CRC care. Methods: The MEDLINE, PsycINFO, CINAHL, and Cochrane databases were searched for articles that focused on interventions to reduce disparities in CRC screening, treatment, survivorship and end-of-life care from 1950 to 2010. Studies included were those that evaluated interventions in US populations that were composed of ≥50% racial/ethnic minorities (or that included a specific sub-analysis by race/ethnicity). Results: Following the electronic search, abstract and full text review, and reference reviews; a total of thirty-three studies were included in our final analysis. All of these were related to CRC screening; no studies evaluating the rest of the cancer care continuum were found. Nineteen studies (58%) were randomized controlled trials, nine (27%) were pre-test/post-test analyses, and five (15%) were cohort studies. Thirteen studies (39%) targeted African-American populations, eight (24%) targeted Hispanics, two (6%) targeted Asian populations, seven (21%) included a mixed population of ethnic minorities, and three (9%) were listed as “non-white” or included a subgroup analysis. The main results related to the magnitude of the effect of these patient-directed, patient navigator, and provider-directed interventions on CRC screening is outlined in the table below. Conclusions: Patient education involving personal contact, patient navigation services, and provider-directed education and reminder systems can modestly improve adherence to CRC screening among minority patients. Further studies targeting the rest of the colon cancer care continuum are needed. [Table: see text]

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Information needs across the colorectal cancer care continuum: scoping the literature

European Journal of Cancer Care ◽

10.1111/j.1365-2354.2012.01340.x ◽

2012 ◽

Vol 21 (3) ◽

pp. 296-320 ◽

Cited By ~ 17

Author(s):

C. VAN MOSSEL ◽

L. LEITZ ◽

S. SCOTT ◽

H. DAUDT ◽

D. DENNIS ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Care ◽

Information Needs ◽

Care Continuum ◽

Cancer Care Continuum

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The Affordable Care Act’s Medicaid Expansion and Impact Along the Cancer-Care Continuum: A Systematic Review

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa043 ◽

2020 ◽

Vol 112 (8) ◽

pp. 779-791 ◽

Cited By ~ 1

Author(s):

Haley A Moss ◽

Jenny Wu ◽

Samantha J Kaplan ◽

S Yousuf Zafar

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Low Income ◽

Cancer Care ◽

Insurance Coverage ◽

Medicaid Expansion ◽

Care Continuum ◽

Patient Protection ◽

Cancer Care Continuum ◽

The Impact

Abstract Background Health reform and the merits of Medicaid expansion remain at the top of the legislative agenda, with growing evidence suggesting an impact on cancer care and outcomes. A systematic review was undertaken to assess the association between Medicaid expansion and the goals of the Patient Protection and Affordable Care Act in the context of cancer care. The purpose of this article is to summarize the currently published literature and to determine the effects of Medicaid expansion on outcomes during points along the cancer care continuum. Methods A systematic search for relevant studies was performed in the PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases. Three independent observers used an abstraction form to code outcomes and perform a quality and risk of bias assessment using predefined criteria. Results A total of 48 studies were identified. The most common outcomes assessed were the impact of Medicaid expansion on insurance coverage (23.4% of studies), followed by evaluation of racial and/or socioeconomic disparities (17.4%) and access to screening (14.5%). Medicaid expansion was associated with increases in coverage for cancer patients and survivors as well as reduced racial- and income-related disparities. Conclusions Medicaid expansion has led to improved access to insurance coverage among cancer patients and survivors, particularly among low-income and minority populations. This review highlights important gaps in the existing oncology literature, including a lack of studies evaluating changes in treatment and access to end-of-life care following implementation of expansion.

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Which Decision Aids to Support Shared Decision Making Have the Potential to Improve Patient Outcomes in Palliative Lung- and Colorectal Cancer Care: Results from a Systematic Review

10.26226/morressier.5c76c8b3e2ea5a7237611f24 ◽

2019 ◽

Author(s):

Liesbeth van Vliet

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Decision Making ◽

Shared Decision Making ◽

Patient Outcomes ◽

Cancer Care ◽

Decision Aids ◽

Shared Decision ◽

Improve Patient

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Selection of patients for large mailed fecal immunochemical test colorectal cancer screening outreach programs: A systematic review

Journal of Medical Screening ◽

10.1177/0969141321997482 ◽

2021 ◽

pp. 096914132199748

Author(s):

Andrew Wang ◽

Briton Lee ◽

Shreya Patel ◽

Evans Whitaker ◽

Rachel B Issaka ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Health Care ◽

Cancer Screening ◽

Patient Selection ◽

Implementation Strategies ◽

Screening Programs ◽

Crc Screening ◽

Key Informant ◽

Immunochemical Test

Objective Digital health care offers an opportunity to scale and personalize cancer screening programs, such as mailed outreach for colorectal cancer (CRC) screening. However, studies that describe the patient selection strategy and process for CRC screening are limited. Our objective was to evaluate implementation strategies for selecting patients for CRC screening programs in large health care systems. Methods We conducted a systematic review of 30 studies along with key informant surveys and interviews to describe programmatic implementation strategies for selecting patients for CRC screening. PubMed and Embase were searched since inception through December 2018, and hand searches were performed of the retrieved reference lists but none were incorporated ( n = 0). No language exclusions were applied. Results Common criteria for outreach exclusion included: being up-to-date with routine CRC screening ( n = 22), comorbidities ( n = 20), and personal history ( n = 22) or family history of cancer ( n = 9). Key informant surveys and interviews were performed ( n = 28) to understand data sources and practices for patient outreach selection, and found that 13 studies leveraged electronic medical care records, 10 studies leveraged a population registry (national, municipal, community, health), 4 studies required patient opt-in, and 1 study required primary care provider referral. Broad ranges in fecal immunochemical test completion were observed in community clinic ( n = 8, 31.0–59.6%), integrated health system ( n = 5, 21.2–82.7%), and national regional CRC screening programs ( n = 17, 23.0–64.7%). Six studies used technical codes, and four studies required patient self-reporting from a questionnaire to participate. Conclusion This systematic review provides health systems with the diverse outreach practices and technical tools to support efforts to automate patient selection for CRC screening outreach.

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Racial and ethnic disparities in colorectal cancer incidence and mortality

Advances in Cancer Research - Novel Approaches to Colorectal Cancer ◽

10.1016/bs.acr.2021.02.007 ◽

2021 ◽

pp. 197-229

Author(s):

John M. Carethers

Keyword(s):

Colorectal Cancer ◽

Cancer Incidence ◽

Ethnic Disparities ◽

Racial And Ethnic Disparities ◽

Incidence And Mortality ◽

Colorectal Cancer Incidence

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356 RACIAL AND ETHNIC DISPARITIES IN SURVIVAL AMONG PATIENTS WITH HEPATOCELLULAR CARCINOMA IN THE UNITED STATES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Gastroenterology ◽

10.1016/s0016-5085(21)00903-3 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-67

Author(s):

Nicole E. Rich ◽

Christian Carr ◽

Adam Yopp ◽

Jorge A. Marrero ◽

Amit G. Singal

Keyword(s):

United States ◽

Hepatocellular Carcinoma ◽

Systematic Review ◽

Meta Analysis ◽

Ethnic Disparities ◽

The United States ◽

Racial And Ethnic Disparities

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Colon capsule endoscopy in colorectal cancer screening: a systematic review

Endoscopy ◽

10.1055/a-1308-1297 ◽

2021 ◽

Author(s):

Fanny E. R. Vuik ◽

Stella A. V. Nieuwenburg ◽

Sarah Moen ◽

Cristiano Spada ◽

Carlo Senore ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Capsule Endoscopy ◽

Detection Rate ◽

Screening Tool ◽

Completion Rates ◽

Crc Screening ◽

Colon Capsule Endoscopy ◽

Screening Population ◽

Colon Capsule

Abstract Introduction Primary colonoscopy and fecal immunochemical test (FIT) are the most commonly used colorectal cancer (CRC) screening modalities. Colon capsule endoscopy (CCE) might be an alternative. Data on the performance of CCE as a CRC screening tool in a screening population remain scarce. This is the first systematic review to provide an overview of the applicability of CCE as a CRC screening tool. Methods A systematic search was conducted of literature published up to September 2020. Studies reporting on CRC screening by second-generation CCE in an average-risk screening population were included. Results 582 studies were identified and 13 were included, comprising 2485 patients. Eight studies used CCE as a filter test after a positive FIT result and five studies used CCE for primary screening. The polyp detection rate of CCE was 24 % – 74 %. For polyps > 6 mm, sensitivity of CCE was 79 % – 96 % and specificity was 66 % – 97 %. For polyps ≥ 10 mm, sensitivity of CCE was 84 % – 97 %, which was superior to computed tomographic colonography (CTC). The CRC detection rate for completed CCEs was 93 % (25/27). Bowel preparation was adequate in 70 % – 92 % of examinations, and completion rates varied from 57 % to 92 %, depending on the booster used. No CCE-related complications were described. Conclusion CCE appeared to be a safe and effective tool for the detection of CRC and polyps in a screening setting. Accuracy was comparable to colonoscopy and superior to CTC, making CCE a good alternative to colonoscopy in CRC screening programs, although completion rates require improvement.

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