Search

PURPOSE: Since 2016, the American College of Surgeons' Commission on Cancer (CoC) has required routine distress screening (DS) of cancer survivors treated in their accredited facilities to facilitate early identification of survivors with psychosocial concerns. Lung and ovarian cancer survivors have relatively low 5-year survival rates and may experience high levels of distress. We examined the extent to which ovarian and lung cancer survivors received CoC-mandated DS and whether DS disparities exist on the basis of diagnosis, sociodemographic factors, or facility geography (urban/rural). METHODS: This study included a quantitative review of DS documentation and follow-up services provided using existing electronic health records (EHRs). We worked with 21 CoC-accredited facilities across the United States and examined EHRs of 2,258 survivors from these facilities (1,618 lung cancer survivors and 640 ovarian cancer survivors) diagnosed in 2016 or 2017. RESULTS: Documentation of DS was found in half (54.8%) of the EHRs reviewed. Disparities existed across race/ethnicity, cancer type and stage, and facility characteristics. Hispanic/Latino and Asian/Pacific Islander survivors were screened at lower percentages than other survivors. Patients with ovarian cancer, those diagnosed at earlier stages, and survivors in urban facilities had relatively low percentages of DS. Non-Hispanic Black survivors were more likely than non-Hispanic White survivors to decline further psychosocial services. CONCLUSION: Despite the mandate for routine DS in CoC-accredited oncology programs, gaps remain in how many and which survivors are screened for distress. Improvements in DS processes to enhance access to DS and appropriate psychosocial care could benefit cancer survivors. Collaboration with CoC during this study led to improvement of their processes for collecting DS data for measuring standard adherence.

The reporting and analysis of population-based cancer statistics in the United States has traditionally been done for counties. However, counties are not ideal for analysis of cancer rates, due to wide variation in population size, with larger counties having considerable sociodemographic variation within their borders and sparsely populated counties having less reliable estimates of cancer rates that are often suppressed due to confidentiality concerns. There is a need and an opportunity to utilize zone design procedures in the context of cancer surveillance to generate coherent, statistically stable geographic units that are more optimal for cancer reporting and analysis than counties. To achieve this goal, we sought to create areas within each US state that are: 1) similar in population size and large enough to minimize rate suppression; 2) sociodemographically homogeneous; 3) compact; and 4) custom crafted to represent areas that are meaningful to cancer registries and stakeholders. The resulting geographic units reveal the heterogeneity of rates that are hidden when reported at the county-level while substantially reducing the need to suppress data. We believe this effort will facilitate more meaningful comparative analysis of cancer rates for small geographic areas and will advance the understanding of cancer burden in the United States.

Introduction: US National Cancer Institute’s (NCI) Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE®) is a library of 78 symptom terms and 124 items enabling patient reporting of symptomatic adverse events in cancer trials. This multicenter study used mixed methods to develop an Italian language version of this widely accepted measure, and describe the content validity and reliability in a diverse sample of Italian-speaking patients. Methods: All PRO-CTCAE items were translated in accordance with international guidelines. Subsequently, the content validity of the PRO-CTCAE-Italian was explored and iteratively refined through cognitive debriefing interviews. Participants (n=96; 52% male; median age 64 years; 26% older adults; 18% lower educational attainment) completed a PRO-CTCAE survey and participated in a semi-structured interview to determine if the translation captured the concepts of the original English language PRO-CTCAE, and to evaluate comprehension, clarity and ease of judgement. Test-retest reliability of the finalized measure was explored in a second sample (n=135). Results: Four rounds of cognitive debriefing interviews were conducted. The majority of PRO-CTCAE symptom terms, attributes and associated response choices were well-understood, and respondents found the items easy to judge. To improve comprehension and clarity, the symptom terms for nausea and pain were rephrased and retested in subsequent interview rounds. Test-retest reliability was excellent for 41/49 items (84%); the median intraclass correlation coefficient was 0.83 (range 0.64-0.94). Discussion: Results support the semantic, conceptual and pragmatic equivalence of PRO-CTCAE-Italian to the original English version, and provide preliminary descriptive evidence of content validity and reliability.

Background We sought to understand barriers and facilitators to implementing distress screening (DS) of cancer patients to inform and promote uptake in cancer treatment facilities. We describe the recruitment and data collection challenges and recommendations for assessing DS in oncology treatment facilities. Methods We recruited CoC-accredited facilities and collected data from each facility’s electronic health record (EHR). Collected data included cancer diagnosis and demographics, details on DS, and other relevant patient health data. Data were collected by external study staff who were given access to the facility’s EHR system, or by facility staff working locally within their own EHR system. Analyses are based on a pilot study of 9 facilities. Results Challenges stemmed from being a multi-facility-based study and local institutional review board (IRB) approval, facility review and approval processes, and issues associated with EHR systems and the lack of DS data standards. Facilities that provided study staff remote-access took longer for recruitment; facilities that performed their own extraction/abstraction took longer to complete data collection. Conclusion Examining DS practices and follow-up among cancer survivors necessitated recruiting and working directly with multiple healthcare systems and facilities. There were a number of lessons learned related to recruitment, enrollment, and data collection. Using the facilitators described in this manuscript offers increased potential for working successfully with various cancer centers and insight into partnering with facilities collecting non-standardized DS clinical data.

140 Background: The challenges of cancer patients in rural areas are well-documented. Most rural hospitals do not deliver on-site cancer care services and lack infrastructure, specialty physicians and oncology-trained support personnel (i.e., nurses, advanced practice providers, and pharmacists) to deliver infusion services. Because of this, cancer patients travel long distances to receive treatment. Travel distance is associated with an increased financial burden and worse outcomes with cancer, including later stage at diagnosis, less timely receipt of chemotherapy, and delay or declination of treatment. According to America’s Health Rankings, high geographic disparity within the state of Montana remains a significant challenge to overall health. Chronic understaffing of oncologists further exacerbates the geographic barrier to cancer care. Methods: To assess the impact of these combined access barriers to cancer treatment, we utilized 5 year cumulative data (2014-2018) from the Montana tumor registry database to assess the impact of geographic disparity on cancer care for patients in Montana. Results: Overall 19.2% of Montanans did not receive treatment following a cancer diagnosis. This is similar to the percentage of cancer patients in Delaware that did not receive treatment (19.1%). Although the population of Delaware is similar to Montana, it is 1.3% of the size. While this suggests that distance may not impact the receipt of treatment for cancer, further analysis of treatment data for Montana by county demonstrated broad discrepancies in the receipt of treatment: No treatment ranged from 12.5% to 30.3%. When mapped geographically the counties with the highest percentage of “no treatment” were distant from the 8 Commission on Cancer-approved cancer centers within the state. A similar county-by-county analysis demonstrated no apparent relationship of “no treatment” with either socioeconomic deprivation or lack of insurance. Distance from Commission on Cancer-approved centers also correlated with traveling out of state to receive care. Conclusions: This analysis provides insight into the impact of geographic barriers on cancer treatment in Montana and identifies remote sites that could benefit from robust outreach and care services to improve cancer care delivery.

Purpose: We sought to determine if there were racial/ethnic disparities in the receipt of initial, cure-intended treatment for localized prostate cancer. Methods: We analyzed prostate cancer cases reported in 2004-2013 to Surveillance, Epidemiology and End Results (SEER) cancer registries, linked with Medicare claims from 2003-2014. We focused on cases that were fee-for-service with continuous Part A and B Medicare from 12 months before first diagnosis to 6 months after diagnosis, and that had American Joint Committee on Cancer 6th Edition tumor extent T1 or T2 without metastatic disease. We used SEER race/ethnicity to categorize cases as non-Hispanic whites; non-Hispanic blacks; non-Hispanic Asian or Pacific Islanders; Hispanics of any race; and Other/Unknown. We defined initial treatment to include 1 month before to 6 months after first diagnosis; cure-intended radical prostatectomy to include radical prostatectomy with or without radiation therapy; cure-intended radiation therapy to include radiation therapy without a radical prostatectomy; and noncurative treatment to include other initial treatment or no treatment. We used multivariable logistic regression to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for receipt of each category of initial treatment, compared with the remaining cases, and adjusting for race/ethnicity; life expectancy from the man's age at diagnosis; pretreatment prostate cancer disease recurrence risk category; Charlson comorbidity score; year of diagnosis; SEER registry region, census tract poverty; and metropolitan or nonmetropolitan county location. Results: Our final study cohort included a total of 125,072 men, with 95,763 non-Hispanic white, 13,616 non-Hispanic black, 4,658 non-Hispanic Asian or Pacific Islanders, 7,933 Hispanic any race, and 3,102 in the Other/Unknown category. After adjustment for multiple variables, non-Hispanic blacks were less likely than non-Hispanic whites to receive initial radical prostatectomy (with or without radiation therapy) (OR, 0.57; 95% CI, 0.53-0.61) or initial radiation therapy without radical prostatectomy (OR, 0.85; 95% CI, 0.82-0.88), and more likely to receive noncurative treatment (OR, 1.51; 95% CI, 1.45-1.57). Non-Hispanic Asian or Pacific Islanders were more likely than non-Hispanic whites to receive initial radiation therapy without radical prostatectomy (OR, 1.23; 95% CI, 1.16-1.31), and less likely to receive noncurative treatment (OR, 0.84; 95% CI, 0.78-0.89). The adjusted odds ratios for curative and noncurative initial treatment received by Hispanics of any race were similar to those for non-Hispanic whites. Conclusion: Compared with non-Hispanic whites, non-Hispanic black men were less likely to receive curative and more likely to receive noncurative initial treatment for localized prostate cancer during 2004-2013. Citation Format: Thomas B. Richards, David G. Stinchcomb, Timothy S. McNeel, Wilhelmina Ross, Diane Ng. Racial-ethnic disparities in the receipt of initial, cure-intended treatment for localized prostate cancer, SEER Medicare, 2004-2013 [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B023.

OBJECTIVE: Among Asian Americans, colorectal cancer (CRC) is the second leading cause of cancer deaths. Despite strong evidence that screening can reduce CRC-related mortality, fewer Chinese and Koreans receive screening as compared to non-Hispanic whites and blacks. The objective of this study was to examine facilitators and barriers as well as strategies to promote CRC screening in this population. DESIGN: This study employed a mixed-methods design. We conducted 17 key informant interviews and 12 focus groups in the Washington, D.C. metropolitan area. 120 Chinese and Korean focus group participants, aged 50 to 85, also provided quantitative data through self-administered surveys. All participants were asked to discuss facilitators and barriers of CRC screening, including in relation to culture. RESULTS: Participants who had a regular physician and doctor’s recommendation for CRC screening were more likely to ever receive a colonoscopy (adjusted odds ratio (aOR)= 3.51; 95% confidence interval (CI): 1.26, 9.79 and aOR=6.61; 95% CI: 2.63, 16.65, respectively). A doctor’s recommendation was also significantly associated with receipt of a fecal occult blood test (FOBT) (aOR=4.00; 95% CI: 1.43, 11.15). In terms of barriers, those who reported having no time and not having symptoms were less likely to have a colonoscopy (aOR=0.15; 95% CI: 0.03, 0.82 and aOR= 0.02; 95% CI: 0.002, 0.23, respectively) than those who had time and symptoms. Preventive healthcare was often not viewed as a priority, particularly for those living the “immigrant life,” who gave precedence to work. Cultural barriers to CRC screening included language (e.g., limited English proficiency and low health literacy); fear of finding CRC and burdening the family especially children; fatalism; and stigma towards cancer. CONCLUSIONS: Future interventions and programs aiming to increase CRC screening among Chinese and Korean Americans should address both cultural and non-cultural factors that influence CRC screening uptake.

Background: Among Asian Americans, colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer death. Although screening has been found to significantly reduce CRC mortality, Chinese and Korean Americans continue to report lower CRC screening rates than White and African Americans. Therefore, this study aims to examine the barriers and facilitators of CRC screening, taking into account a cultural perspective, in these underserved populations. Methods: We employed a mixed methods study to gain further understanding regarding CRC screening behaviors among Asian Americans. Specifically, we collected quantitative data through surveys from 120 participants, who were self-identified Chinese and Korean Americans, aged 50 years and over. Multivariable-adjusted logistic regression was conducted to analyze survey data, independently assessing for receipt of colonoscopy and fecal occult blood test (FOBT). In addition, qualitative data from 17 key informant interviews (with physicians, health department employees, patient navigators, and community leaders) and 12 focus groups (n=120) were transcribed, translated to English, back-translated to ensure accuracy, coded, and analyzed for salient themes. Results: Based on focus group findings, major cultural themes influencing CRC screening included language- and health-related attitudes and beliefs. In particular, participants identified having limited English proficiency, low health literacy, and reliance on children for translation as being key barriers. Thus, participants emphasized the importance of having linguistically appropriate services, such as patient navigators. Additional barriers included fearing a CRC diagnosis, having fatalistic views of CRC, and facing stigma towards cancer. In addition, quantitative analysis found that individuals who believed screening is not needed when asymptomatic were less likely to receive a colonoscopy (Odds Ratio (OR): 0.02; 95% Confidence Interval (CI): 0.002-0.23) and FOBT (OR: 0.16; 95% CI: 0.03-0.72). These findings were supported by key informants and focus group participants, who expressed that Chinese and Koreans often times do not prioritize preventive healthcare and believe that seeking healthcare is not necessary when symptoms are not noticeable. Moreover, this study corroborated previous findings of non-cultural factors influencing CRC screening such as cost, insurance, knowledge, and time -some of which were influenced by underlying cultural attitudes and beliefs. Patient-physician communication was another key influential factor. For instance, those having a doctor talk about [(OR: 6.1; 95% CI: 2.4-15.4) for colonoscopy; (OR: 3.1; 95% CI: 1.1-8.5) for FOBT)] or recommend CRC screening [(OR: 6.6; 95% CI: 2.6-16.7) for colonoscopy; (OR: 4.0; 95% CI: 1.4-11.2) for FOBT)] were more likely to have received screening. Conclusions: Receipt of CRC screening is influenced by cultural and non-cultural factors, both of which need to be addressed in order to increase screening uptake among Chinese and Korean Americans. These findings can inform the development of more effective CRC screening programs and interventions that are culturally and linguistically tailored to these populations. Citation Format: Sunmin Lee, Mary Jung, Xiaoxiao Lu, Jamie Sim, Diane Ng. Examining colorectal cancer screening barriers and facilitators though a cultural lens: A mixed methods study of Chinese and Korean Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B73.