The effects of race/ethnicity and physician recommendation for physical activity on physical activity levels and arthritis symptoms among adults with arthritis

Background Among U.S. adults with physician-diagnosed arthritis, we examined the association of 1) participant race/ethnicity with meeting physical activity guidelines and arthritis symptoms, and 2) the association of receipt of a physician exercise recommendation with physical activity levels and arthritis symptoms, and whether race/ethnicity moderates these associations. Methods Retrospective, cross-sectional study of National Health Interview Survey pooled data from 2002, 2006, 2009, and 2014 from 27,887 U.S. adults aged ≥18 years with arthritis. Outcomes were meeting aerobic (yes/no) and strengthening guidelines (yes/no), arthritis-associated activity limitations (yes/no) and arthritis-related pain (0–10; higher score = more pain). Predictors were race/ethnicity (White, African American, Latino, and Asian) and receipt of physician recommendation for exercise (yes/no). Covariates included demographic and health characteristics. Results Adjusting for covariates, African Americans were more likely (AOR = 1.27; 95% CI 1.12, 1.43) and Asians were less likely (AOR = 0.75; 95% CI 0.61, 0.92) than Whites to meet muscle strengthening activity guidelines. Compared to Whites, African Americans (B = 0.48; 95% CI 0.24, 0.72) and Latinos (B = 0.44; 95% CI 0.15, 0.72) reported more severe, while Asians reported less severe (B = -0.68; 95% CI -1.22, − 0.14) joint pain. Controlling for covariates, physician exercise recommendation was associated with meeting aerobic (AOR = 1.20; 95% CI 1.11, 1.30) and strengthening (AOR = 1.21; 95% CI 1.11, 1.33) guidelines, regardless of race/ethnicity except for a weak negative association with meeting strengthening guidelines (AOR = 0.85; CI 0.74–0.99) among Latinos. Conclusions Disparities in pain exist for African Americans and Latinos with arthritis. Physician exercise recommendation is critical among patients with arthritis to relieve symptom burden.

Patients’ Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

Background. In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods. We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results. Despite a physician recommendation to stop screening, 29% of respondents reported being “not at all likely” to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion. Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources.

Vaccine Enthusiasm and Hesitancy in Cancer Patients and the Impact of a Webinar

(1) Background: Vaccine hesitancy and rejection are major threats to controlling coronavirus disease 2019 (COVID-19). There is a paucity of information about the attitudes of cancer patients towards vaccinations and the role of clinical oncologists in influencing vaccination acceptance. (2) Methods: Cancer patients and caregivers were invited to participate in a webinar and two surveys (pre- and post-webinar) assessing intention and thought processes associated with receiving COVID-19 vaccines. (3) Results: Two hundred and sixty-four participants participated in the webinar and registered to take at least one survey. Participants reported receiving most of their COVID-19 vaccine information from their doctor, clinic, or hospital. Before the webinar, 71% of participants reported the intention to receive a COVID-19 vaccine, 24% were unsure, and 5% had no intention of receiving a vaccine. The strongest predictors of vaccine enthusiasm were (a) planning to encourage the vaccination of family, friends, co-workers, and community, and (b) physician recommendation. The chief reason for vaccine hesitancy was a fear of side effects. After the webinar, 82.5% reported the intention to receive a vaccine, 15.4% were still unsure, and 2% stated that they had no intention of receiving a vaccine. The webinar shifted the attitude towards vaccine enthusiasm, despite an already vaccine-enthusiastic population. Communicating about vaccines using positive framing is associated with greater vaccine enthusiasm. (4) Conclusions: Patient education programs co-hosted by multiple stakeholders and delivered by oncologists can increase cancer patient enthusiasm for COVID-19 vaccination.

The Views of the Public on Making Decisions about over the Counter Medications and Their Attitudes towards Evidence of Effectiveness

Aim: This study aimed to determine the public views on making decisions about over the counter drugs and their attitudes towards evidence of their effectiveness. Methodology: The present study includes gathering data from the public using a survey that was adapted from a previous study. This survey was translated from English to Arabic language and was converted to an online form using Google Forms and then the link was sent to be completed by the public. Results: The survey was completed by 102 respondents. Most of the respondents agreed that the most important factors that influence their purchases of medications were the safety of the product (73.53%) and the efficacy of the drug (71.57). Most of the respondents agreed that the main methods of determining the effectiveness of the medication included the previous using of the drug (76.5%) and the physician recommendation to use it by a (75.5%). Only about 49.02% of them agreed that the majority of non-prescription medicines are supported by scientific evidence from drug trials to prove they are effective. Conclusion: This study highlighted positive views and attitudes toward the use of OTC drugs. It is important to increase the awareness of the public about how to use these drugs wisely. Community pharmacists should play a crucial role in optimizing medication use and in patients counseling.

The Effects of Race/Ethnicity and Physician Recommendation for Physical Activity on Physical Activity Levels and Arthritis Symptoms Among Adults With Arthritis

Background: Among U.S. adults with physician-diagnosed arthritis, we examined the effects of race/ethnicity and receiving physician exercise recommendation on meeting aerobic and strengthening physical activity guidelines, and arthritis symptoms, and whether race/ethnicity moderates the effects of physician recommendation on activity levels and symptoms.Methods: Retrospective, cross-sectional study of National Health Interview Survey pooled data from 2002, 2006, 2009, and 2014. The study included 27,887 U.S. adults aged ≥18 years with arthritis. Outcomes were meeting aerobic (yes/no) and strengthening guidelines (yes/no), arthritis-associated activity limitations (yes/no) and arthritis-related pain (0-10; higher score=more pain). Predictors were race/ethnicity (White, African American, Latino, and Asian) and receipt of physician recommendation for exercise (yes/no). Covariates included demographic and health characteristics and U.S. region.Results: Controlling for covariates, physician exercise recommendation was independently associated with meeting aerobic (AOR=1.14; 95% CI 1.06, 1.24) and strengthening (AOR=1.17; 95% CI 1.06, 1.28) guidelines; effects did not differ by race/ethnicity. African Americans were more likely than Whites to meet strengthening guidelines (AOR=1.22; 95% CI 1.07, 1.40) and Asians were less likely to meet aerobic (AOR=0.80; 95% CI 0.65, 0.99) and strengthening (AOR=0.76; 95% CI 0.60, 0.96) guidelines. Compared to Whites, African Americans (B=0.51; 95% CI 0.26, 0.76) and Latinos (B=0.43; 95% CI 0.14, 0.72) reported more severe, while Asians reported less severe (B=-0.60; 95% CI -1.17, -0.04) joint painConclusions: Disparities in pain exist for African Americans and Latinos with arthritis. Physician exercise recommendation is critical among patients with arthritis to relieve symptom burden.

Factors Associated With Physician Recommendation of Home Blood Pressure Monitoring and Blood Pressure in the US Population

BACKGROUND Hypertension guidelines recommend home blood pressure monitoring (HBPM) to help achieve blood pressure (BP) control. We hypothesized that HBPM use with a physician recommendation would be associated with lower BP and greater medication adherence. METHODS We used data from 6,320 adults with hypertension in the National Health and Nutrition Examination Survey 2009–2014 to characterize the association of (i) provider recommendation for HBPM and (ii) HBPM use on 2 outcomes: measured BP (linear regression) and medication adherence (logistic regression). Provider recommendation, HBPM use, and medication use were self-reported. RESULTS Among adults with hypertension, 30.1% reported a physician recommendation for HBPM, among whom 82.0% reported using HBPM. Among those who did not report a physician recommendation for HBPM, 28.3% used HBPM. Factors associated with a physician recommendation were having health insurance, higher education attainment, hypertension awareness, and having a prescription for antihypertensive medication. Among those who reported receiving a physician recommendation, those who used HBPM had a mean BP that was 3.1/4.5 mm Hg lower than those who did not. Those who reported having a physician recommendation and using HBPM were more likely to report hypertension medication adherence (odds ratio 2.9; 95% confidence interval: 2.0, 4.4). CONCLUSIONS HBPM use was associated with lower BP and higher medication adherence. Use of HBPM was higher among those with a physician recommendation. These results support a role for physicians in counseling and partnering with patients on HBPM use for BP management.

Sociodemographic and Clinical Characteristics Associated with Patient's Decision to Refuse Multiple Myeloma (MM) Treatment, and Its Impact on Outcomes

Background: MM is associated with significant morbidity even at the time of presentation and there is ample data to support that MM treatment improves overall survival (OS) as well as quality of life (QoL) due to effective symptom control. Patient refusal to recommended cancer treatment is not common in clinical practice but has been reported in certain cancers. There is no data on characteristics of MM patients who refuse treatment despite physician recommendation and outcomes of such patients. Methods: We used the National Cancer Database (NCDB) from 2004-2015 to extract data on adult MM patients who refused any systemic therapy as part of their initial care despite physician recommendation. Information on patient age, gender, race/ethnicity, education, year of diagnosis, income, geographical location, comorbidities, systemic treatment, survival time and vital status was obtained. Average annual percent change (AAPC) and average percent change (APC) were calculated to analyze the trends, and periods with similar APC were compared for statistically significant changes by applying join point regression. Multivariate models were employed to identify factors predicting refusal to therapy and to assess its impact on OS. Results: Of 75,734 eligible patients who were recommended treatment for MM (chemotherapy and or immunotherapy), 2138 (2.8%) patients did not receive any treatment due to refusal. Significantly higher number of females, patients in older age groups (age groups 60-79 and ³ 80 years), Medicare recipients and with ≥2 comorbidities refused treatment recommendation. On multivariate analysis, advanced age groups 60-79 years (OR = 1.47; 95% CI 1.27-1.31 p<0.001) and ³80 years (OR = 5.02; 95% CI 4.23-5.96, p<0.001), female gender (OR =1.16 ; 95% CI 1.05-1.27, p<0.001), patients with certain primary payor types including Medicaid (OR = 1.59; 95% CI 1.28-1.98, p<0.001), Medicare (OR = 1.63; 95% CI 1.43-1.87, p<0.001) and uninsured (OR = 1.81; 95% CI 1.38-2.38, p<0.001), and presence of ³2 comorbidities (OR = 1.39; 95% CI 1.2-1.61, p<0.001) were the independent factors associated with higher likelihood of refusing treatment. Whereas being seen at academic research programs (OR = 0.7; 95% CI 0.6-0.8, p<0.001), higher education (OR =0.81 ; 95% CI 0.67-0.98, p=0.03), geographical location (Midwest OR =0.87 ; 95% CI 0.76-0.99, p=0.04), longer distance to facility being at 3rd quartile (10.1-26.2 miles: OR =0.78 ; 95% CI 0.68-0.89, p<0.001) or 4th quartile (>26.2 miles: OR = 0.59; 95% CI 0.51-0.68, p<0.001) were associated with lower likelihood of refusing treatment. The overall rate of refusing treatment by MM patients was quite stable during 2004-2015 with an AAPC of 1.1 (95% CI -1.1-3.3 p=0.3). However, on fitting scatter plot into Joinpoint regression model, a concerning trend in the more recent years was noted. While the rate of refusing recommended treatment decreased during 2004-2008, a rising trend was observed during the period 2008-2015 with an APC of 3.8 (95% CI 1.3-6.4, p≤0.001) (Fig 1a). Patients who were recommended treatment but refused had significantly worse survival than those who received treatment (median survival 17.7 vs 52.9 months, Cox hazard ratio 1.21; CI 1.17-1.24, p<0.001) (Fig 1b). Conclusions: The percentage of MM patients refusing any systemic treatment as a part of their initial care despite physician recommendation appears to be increasing in recent years and this needs to be systematically addressed. Disparities in refusal to recommended treatment are independently associated with several variables including age, gender, comorbidities, geographical location, facility and insurance type. These need to be addressed urgently since there are several effective and well-tolerated anti-MM treatments which can potentially benefit patients in case the initial socioeconomic, clinical and psychosocial barriers are overcome. Disclosures Chanan-Khan: Xencor: Research Funding; Pharmacyclics: Research Funding; Merck: Research Funding; Jansen: Research Funding; Mayo Clinic: Employment; Ascentage: Research Funding; Millennium: Research Funding; AbbVie: Research Funding. Ailawadhi:Pharmacyclics: Research Funding; Celgene: Consultancy; Amgen: Consultancy, Research Funding; Cellectar: Research Funding; Janssen: Consultancy, Research Funding; Takeda: Consultancy.