Through the Lens: Youth Experiences with Cancer in Rural Appalachian Kentucky Using Photovoice

Rural Appalachian Kentucky experiences disproportionately high cancer incidence and mortality rates. This cancer burden is due to social determinants of health and cultural factors prominent in the region. The firsthand experiences of community members—especially young people—can highlight these factors and identify areas for improvement. The purpose of this study was to encourage Appalachian Kentucky youth to consider determinants of cancer and visualize the effects that cancer has on their families or communities by asking them to take photographs of cancer-related objects around them. Content analysis was performed on 238 photographs submitted by 25 students, and photographs were organized into themes, subthemes, and subtopics. The six themes that emerged were risk factors and exposures, marketing, awareness and support, health care, experiences, and metaphorical representations. Many of the submitted photographs aligned with cultural, environmental and/or situational factors prevalent in Appalachian Kentucky. Of the submitted photographs, 54 were displayed as an installment in two Kentucky art galleries. Viewer comments at the exhibitions demonstrated that young community members can educate and motivate change in those around them. Ultimately, this project demonstrates that young community members can recognize cancer-related issues around them and connect personal experiences back to the larger Appalachian Kentucky cancer disparity while also having an impact on other community members.

Do Patients Residing in Provincial Areas Transport and Spend More on Cancer Treatment in Korea?

Background: With the increasing burden of cancer worldwide, a need exists to investigate patterns of healthcare utilization and costs. This study aimed to investigate whether the area of residence is associated with the likelihood of a patient receiving treatment at an institution located outside their residing region. This study also analyzed whether medical travel was related to levels of healthcare utilization and costs. Methods: This study used the 2007 to 2015 National Health Insurance (NHI) claims data. The residing area was categorized into capital area, metropolitan cities, and provincial area. Healthcare utilization was measured based on days of care and costs based on direct, covered medical costs. Chi-square test and analysis of variance (ANOVA) was conducted to investigate the general characteristics of the study population. The relationship between the dependent and independent variables were analyzed using the generalized estimating equation (GEE) model. Results: Of the 64,505 participants included in this study, 19,975 (31.0%) visited medical institutions located outside their residing area. Compared to individuals residing in the capital area, those living in provincial regions (OR 2.202, 95% CI 2.068–2.344) were more likely to visit medical institutions outside their residing area. Healthcare costs were higher in individuals receiving treatment at hospitals located elsewhere (RR 1.054, 95% CI 1.017–1.093). Conclusion: Cancer patients residing in provincial areas were likely to visit institutions located outside their residing area for treatment. Medical travel was associated with higher levels of spent healthcare costs. Policies should focus on preventing possible related regional cancer disparity and promoting optimal configuration of cancer services.

Cancer Clinical Trials in Africa—An Untapped Opportunity: Recommendations From AORTIC 2019 Conference Special Interest Group in Clinical Trials

Cancer is now a formidable health care burden in sub-Saharan Africa (SSA) due to lifestyle westernization and longer life expectancy. The exponential increase in cancer incidence coupled with high mortality rate is not comparable with that seen in westernized countries. To address global cancer disparity, globalization of cancer clinical trials to involve sub-Saharan Africa can serve as a platform where innovative targeted therapies can be made available to patients in the environ. In the 2019 African Organization for Research and Training in Cancer (AORTIC) conference held at Maputo, Mozambique, a group of clinical trialists spanning across multiple continents highlighted the opportunities in Africa for the conduct of cancer clinical trials. The secondary purpose of the meeting was to address the belief that Africa was incapable of conducting interventional cancer trials but showed the in-continent strengths, such as available capacities, trained local clinical trialists with clinical trial experiences, clinical trial consortia, local capabilities, mapping out logistics, ethical consideration, political will, real-time benefits of clinical trials to clinical practice, and future directions for trials.