Use of formal and informal mental health resources by cancer survivors: differences between rural and nonrural survivors and a preliminary test of the theory of planned behavior

Objective: Previous research has identified rural residence as a risk factor for poorer mental health (MH) outcomes in cancer survivors. This may be due to less use of various MH resources due to poorer access and less favorable attitudes and social norms related to MH resource utilization. The present study sought to examine use of MH resources in rural and nonrural survivors and identify factors associated with MH resource use. Methods: Cancer survivors (n=113, 1–5 years postdiagnosis) completed a questionnaire packet and telephone interview. Accessibility and postdiagnosis use of various formal and informal MH resources were assessed along with constructs potentially linked to use of MH resources by the Theory of Planned Behavior (TPB; personal attitude, social norm, perceived behavioral control). Results: Results indicated no widespread differences between rural and nonrural cancer survivors in MH resource use although some evidence suggested poorer accessibility and less use of mental health professionals and cancer support groups among rural survivors. In general, rural survivors reported less favorable personal attitudes and social norms regarding MH resource use. TPB constructs accounted for a significant portion of variance in use of most MH resources with personal attitudes generally being the strongest predictor of MH resource use. Conclusions: Additional research is needed to expand the search for factors, particularly modifiable factors, which might account for disparities in MH outcomes between rural and nonrural survivors. Copyright © 2009 John Wiley & Sons, Ltd.     

Associations of Self-rated Health and Socioeconomic Status with Information Seeking and Avoiding Behavior among Post-Treatment Cancer Patients

This study investigated how self-rated health and socioeconomic status are associated with behaviour ofcancer survivors regarding desire for information. For this association, we compared survivors who did notseek information about cancer with those who did. We examined how sociodemographic, socioeconomic, cancerrelated,and health information factors are associated with self-rated health (SRH) by health information seeking/avoiding behavior in a survey of 502 post-treatment cancer patients. In the information seeking group, all fourfactors exhibited significant relationships with SRH. SRH values were significantly high for women (p<0.05),non-Hispanic White (p<0.05), and educated (p<0.01) participants, and for those who had high self-efficacy to usehealth information by themselves (p<0.01). Furthermore, in the information avoiding group, not only were thereno significant relationships between socioeconomic status (SES) and SRH, but there were negative associationsbetween their attitude/capacity and the SRH. In terms of communication equity, the promotion of informationseeking behavior can be an effective way to reduce health disparities that are caused by social inequalities.Information avoiding behavior, however, does not exhibit a negative contribution toward the relationship betweenSRH and SES. Information seeking behavior was positively associated with SRH, but avoiding behavior wasnot negatively associated. We thus need to eliminate communication inequalities using health intervention tosupport information seeking behavior, while simultaneously providing support for avoiders.     

Rural‐urban disparities in health status among US cancer survivors

BACKGROUND:

Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural‐urban disparities in self‐reported health among survivors.

METHODS:

The authors identified adults who had a self‐reported history of cancer from the National Health Interview Survey (2006‐2010). Rural‐urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural‐urban differences in health status after accounting for differences in demographic characteristics.

RESULTS:

Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non‐Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20‐1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00‐1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01‐1.32), and health‐related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35‐2.03).

CONCLUSIONS:

The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being. Cancer 2013. © 2012 American Cancer Society.     

The prioritisation of paediatrics and palliative care in cancer control plans in Africa

Background:

Given the burden of childhood cancer and palliative care need in Africa, this paper investigated the paediatric and palliative care elements in cancer control plans.

Methods:

We conducted a comparative content analysis of accessible national cancer control plans in Africa, using a health systems perspective attentive to context, development, scope, and monitoring/evaluation. Burden estimates were derived from World Bank, World Health Organisation, and Worldwide Palliative Care Alliance.

Results:

Eighteen national plans and one Africa-wide plan (10 English, 9 French) were accessible, representing 9 low-, 4 lower-middle-, and 5 upper-middle-income settings. Ten plans discussed cancer control in the context of noncommunicable diseases. Paediatric cancer was mentioned in 7 national plans, representing 5127 children, or 13% of the estimated continental burden for children aged 0–14 years. Palliative care needs were recognised in 11 national plans, representing 157 490 children, or 24% of the estimated Africa-wide burden for children aged 0–14 years; four plans specified paediatric palliative needs. Palliative care was itemised in four budgets. Sample indicators and equity measures were identified, including those highlighting contextual needs for treatment access and completion.

Conclusions:

Recognising explicit strategies and funding for paediatric and palliative services may guide prioritised cancer control efforts in resource-limited settings.     

Should Male Circumcision be Advocated for Genital Cancer Prevention?

The recent policy statement by the Cancer Council of Australia on infant circumcision and cancer preventionand the announcement that the quadrivalent human papillomavirus (HPV) vaccine will be made available forboys in Australia prompted us to provide an assessment of genital cancer prevention. While HPV vaccinationof boys should help reduce anal cancer in homosexual men and cervical cancer in women, it will have little orno impact on penile or prostate cancer. Male circumcision can reduce cervical, penile and possibly prostatecancer. Promotion of both HPV vaccination and male circumcision will synergistically maximize genital cancerprevention.     

Evaluation of the Knowledge and Perceptions with Regards to Pictorial Health Warnings on Tobacco Products among Tobacco Users Diagnosed with Head and Neck Carcinoma: a Study from the Kumaon Hills of India

Background: Tobacco products continue to be used in large quantities in India despite the mandatory inclusionof pictorial health warnings (PHWs) on all tobacco packaging. The circumstances as to how people could continuethe use of tobacco to the point of developing head and neck cancer despite enhanced awareness about the illeffects of tobacco is the main focus of this study. Materials and Methods: This study concerned patients withleast 5-years history of tobacco use, having been diagnosed with histopathologically proven malignancies of thehypopharynx, larynx, oropharynx and oral cavity presenting at the Government Medical College-Haldwani,Nainital, India. A total of 183 patients were eligible for inclusion during July 1 2013- June 30 2014. Of these,59 patients used smoked tobacco exclusively, 22 patients used smokeless tobacco exclusively, and 102 patientsused both forms of tobacco. Among users of smoked forms, 75.2% (n=121) were beedi users, and 24.8% (n=40)were cigarette users. Patients were asked direct questions as to whether they had noticed the presence of PHWsupon tobacco products. The reasons as to why PHWs were not effective in stopping the patients from tobaccouse were investigated. Results: Of the 183 patients, 146 reported being aware about the presence of PHWs, andwhen they were asked reasons as to why they continued tobacco despite being aware of ill-effects, the commonestreason chosen (by 53.4%) was that patients had not regarded themselves as using tobacco heavy enough to causecancer. Among the 36 patients who reported as being oblivious to the presence of PHWs on tobacco products,63.9% reported that the products they used never displayed any PHWs, and 36.1% reported never having paidattention to the packaging. The awareness about PHWs was higher among cigarette smokers in comparisonto beedi smokers (100% vs 76.1%, p=0.0002). Conclusions: Locally produced and marketed tobacco productssuch as beedis and oral tobacco often fail to display PHWs. The presence of PHWs without doubt enhancesawareness about the carcinogenic risks of tobacco. However, enhanced awareness alone may not be enough, andas elucidated by this study, some persons continue to use tobacco to the point of developing malignancies. Theneed of the hour is the implementation of legal and economic sanctions discouraging the use of tobacco products.     

Predictors of timely follow‐up after abnormal cancer screening among women seeking care at urban community health centers

BACKGROUND:

We sought to measure time and identify predictors of timely follow‐up among a cohort of racially/ethnically diverse inner city women with breast and cervical cancer screening abnormalities.

METHODS:

Eligible women had an abnormality detected on a mammogram or Papanicolaou (Pap) test between January 2004 and December 2005 in 1 of 6 community health centers in Boston, Massachusetts. Retrospective chart review allowed us to measure time to diagnostic resolution. We used Cox proportional hazards models to develop predictive models for timely resolution (defined as definitive diagnostic services completed within 180 days from index abnormality).

RESULTS:

Among 523 women with mammography abnormalities and 474 women with Pap test abnormalities, >90% achieved diagnostic resolution within 12 months. Median time to resolution was longer for Pap test than for mammography abnormalities (85 vs 27 days). Site of care, rather than any sociodemographic characteristic of individuals, including race/ethnicity, was the only significant predictor of timely follow‐up for both mammogram and Pap test abnormalities.

CONCLUSIONS:

Site‐specific community‐based interventions may be the most effective interventions to reduce cancer health disparities when addressing the needs of underserved populations. Cancer 2010. © 2010 American Cancer Society.     

Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice,research, and policy

Although cancer mortality rates declined in the United States in recent decades, some populations experienced little benefit from advances in cancer prevention, early detection, treatment, and survivorship care. In fact, some cancer disparities between populations of low and high socioeconomic status widened during this period. Many potentially preventable cancer deaths continue to occur, and disadvantaged populations bear a disproportionate burden. Reducing the burden of cancer and eliminating cancer-related disparities will require more focused and coordinated action across multiple sectors and in partnership with communities. This article, part of the American Cancer Society's Cancer Control Blueprint series, introduces a framework for understanding and addressing social determinants to advance cancer health equity and presents actionable recommendations for practice, research, and policy. The article aims to accelerate progress toward eliminating disparities in cancer and achieving health equity.     

Impact of insurance type on survivor-focused and general preventive health care utilization in adult survivors of childhood cancer: the Childhood Cancer Survivor Study (CCSS)

BACKGROUND:

Lack of health insurance is a key barrier to accessing care for chronic conditions and cancer screening. The influence of insurance type (private, public, none) on survivor‐focused and general preventive health care in adult survivors of childhood cancer was examined.

METHODS:

The Childhood Cancer Survivor Study is a retrospective cohort study of childhood cancer survivors diagnosed between 1970 and 1986. Among 8425 adult survivors, the relative risk (RR) and 95% confidence interval (CI) of receiving survivor‐focused and general preventive health care were estimated for uninsured (n = 1390) and publicly insured (n = 640), compared with for the privately insured (n = 6395)

RESULTS:

Uninsured survivors were less likely than those privately insured to report a cancer‐related visit (adjusted RR, 0.83; 95% CI, 0.75‐0.91) or a cancer center visit (adjusted RR, 0.83; 95% CI, 0.71‐0.98). Uninsured survivors had lower levels of utilization in all measures of care in comparison with privately insured. In contrast, publicly insured survivors were more likely to report a cancer‐related visit (adjusted RR, 1.22; 95% CI, 1.11‐1.35) or a cancer center visit (adjusted RR, 1.41; 95% CI, 1.18‐1.70) than were privately insured survivors. Although publicly insured survivors had similar utilization of general health examinations, they were less likely to report a Papanicolaou test or a dental examinations

CONCLUSIONS:

Among this large, socioeconomically diverse cohort, publicly insured survivors utilize survivor‐focused health care at rates at least as high as survivors with private insurance. Uninsured survivors have lower utilization of both survivor‐focused and general preventive health care. Cancer 2011. © 2010 American Cancer Society.     

Self-reported physical and emotional health of women in a low- fat, high-carbohydrate dietary trial (Canada)

Objectives: While decreased intake of dietary fat may have significant positive effects on women's health by reducing the risk of cancer and other diseases, little research has been carried out to determine the potential adverse effects of dietary fat reduction. This study compares the self-reported physical and emotional health of 402 low fat intervention and control group participants in the Canadian Diet and Breast Cancer Prevention Trial.Methods: Subjects who had been participating in the dietary intervention trial for at least 2 years completed 3 mailed questionnaires: two designed to assess physical and emotional health (MOS 36-Item Short-Form Health Survey (SF-36) and the Women's Health Questionnaire (WHQ)) and a Health Practices Survey.Results: There were no significant differences between the study groups on total scores or any of the subscales/health domains for the SF-36 or the WHQ. In premenopausal women only, intervention group subjects scored significantly lower on the vasomotor symptoms scale, indicating less symptom experience. Frequency of visits to physicians and alternative health practitioners were not significantly different between the study groups.Conclusions: The results of this study suggest that participation in a low-fat, high-carbohydrate dietary intervention did not have any detrimental effects on participants'; self-reported physical health or emotional well-being.     

Who's still smoking? Disparities in adult cigarette smoking prevalence in the United States

The continuing high prevalence of cigarette smoking among specific subpopulations, many of them vulnerable, is one of the most pressing challenges facing the tobacco control community. These populations include individuals in lower education and/or socioeconomic groups; from certain racial/ethnic groups; in the lesbian, gay, bisexual, and transgender community; with mental illness; and in the military, particularly among those in the lowest pay grades. Although traditional tobacco control measures are having positive health effects for most groups, the effects are not sufficient for others. More attention to and support for promising novel interventions, in addition to new attempts at reaching these populations through conventional interventions that have proven to be effective, are crucial going forward to find new ways to address these disparities. CA Cancer J Clin 2018;68:106‐115 . © 2018 American Cancer Society .     

Reproductive Health Experiences of Females Diagnosed with Young-Onset Colorectal Cancer: A Multi-Method Cross-Sectional Survey

Objective: Given the increasing risk of young-onset colorectal cancer (yCRC) among adults under 50 years, it is important to understand impacts on reproductive health. Our objective was to assess experiences with reproductive health after yCRC diagnosis among females. Methods: We conducted a cross-sectional study among females, 18 years or older, who have been diagnosed yCRC and are able to communicate in English. Data were gathered using an online survey involving both quantitative (e.g., multiple choice) and qualitative (e.g., open-ended text) questions on pregnancy history, influence of yCRC on reproductive decisions, and experiences with reproductive healthcare. Results: Altogether, 101 females with yCRC participated, including 23 who had never been pregnant and 78 who had been pregnant. yCRC influenced family planning goals for one-third of participants. Furthermore, compared to participants who completed treatment, those currently undergoing treatment had higher odds of indicating their yCRC diagnosis influenced family planning goals (adjusted odds ratio 4.93; 95% confidence interval 1.29 to 18.78). Although 53 (52.5%) participants indicated having discussions regarding reproductive health with healthcare provider(s), 44 (43.6%) did not. Content analysis of open-ended survey questions identified themes on the emotional impacts, experiences with reproductive healthcare, reproductive and family planning considerations, and the related issue of sexual health impacts of yCRC. Conclusions: Gaps in care, related to limited reproductive health discussions, influence of yCRC on family planning, and experiencing lasting reproductive health impacts highlight the need for improving reproductive healthcare, particularly for females diagnosed with yCRC.     

Prevalence and sociodemographic correlates of beliefs regarding cancer risks

BACKGROUND: Inaccurate beliefs about cancer risk may contribute to unhealthy lifestyle behaviors and poor adherence to recommended screening and prevention guidelines. To address this issue the current study assessed the prevalence and sociodemographic correlates of scientifically unsubstantiated beliefs about cancer risk in a representative sample of the US population. METHODS: Nine hundred fifty-seven US adults with no history of cancer were surveyed by telephone. The survey included 12 statements about cancer risk, risk factors, and prevention that were framed to be contrary to the consensus of current scientific evidence. RESULTS: Participants were inconsistent in their ability to identify the statements as false, and appraisal accuracy was associated with several sociodemographic characteristics. Five of the 12 misconceptions were endorsed as true by at least a quarter of the respondents, and uncertainty was higher than 15% for 7 statements. At the same time, more than two-thirds of the participants were able to identify 7 statements as false and, on average, respondents endorsed fewer than 3 statements as true. Respondents who were male, older, non-White, less educated, and of lower income were most likely to hold inaccurate beliefs. CONCLUSIONS: A notable percentage of the participants in this study hold beliefs about cancer risk at odds with the prevailing scientific evidence. Because the population segments with the least accurate knowledge also bear the greatest burden of cancer, areas for public education and intervention efforts are identified.     

Integrated care in cancer: What is it,how is it used and where are the gaps? A textual narrative literature synthesis

Integrated care is an underpinning concept of contemporary health care policy proffered as a strategy to overcome the fragmentations in care encountered by people with complex care needs (Shaw et al. [2011] What is Integrated Care? An Overview of Integrated Care in the NHS). Cancer patients have potential to benefit from such policy, often having needs that extend beyond cancer. This paper seeks to understand how the concept of integrated care is used in the cancer literature. A search of leading databases was conducted for original research relating to integrated care or an integration intervention aiming to improve outcomes of cancer patients, and analysed using textual narrative synthesis. 38 papers were included, each with a focus on improving cancer‐specific aspects of care enhancing the capabilities of the cancer multidisciplinary team. Of the eight studies involving integration between the cancer service and other care providers, all focused on utilising the external provider to deliver aspects of cancer care or placed them in a passive role, as survey participant, a recipient of cancer‐related clinical information or as the comparator “usual care” arm. Within the cancer literature, integration is predominantly used to describe initiatives to improve cancer‐related aspects of care. Less attention is given to integration initiatives that enhance coordination across levels of the healthcare system or service providers.     

Inequity in Telemedicine Use Among Patients with Cancer in the Deep South During the COVID-19 Pandemic

BackgroundTelemedicine use has increased significantly during the COVID-19 pandemic. It remains unclear if its rapid growth exacerbates disparities in healthcare access. We aimed to characterize telemedicine use among a large oncology population in the Deep South during the COVID-19 pandemic.Materials and MethodsA retrospective cohort study was performed at the only National Cancer Institute designated-cancer center in Alabama March 2020 to December 2020. With a diverse (26.5% Black, 61% rural) population, this southeastern demographic uniquely reflects historically vulnerable populations. All non-procedural visits at the cancer center from March to December 2020 were included in this study excluding those with a department that had fewer than 100 visits during this time period. Patient and clinic level characteristics were analyzed using t-test and Chi-square to compare characteristics between visit types (in-person versus telemedicine, and video versus audio within telemedicine). Generalized estimating equations were used to identify independent factors associated with telemedicine use and type of telemedicine use.ResultsThere were 50 519 visits and most were in-person (81.3%). Among telemedicine visits, most were phone based (58.3%). Black race and male sex predicted in-person visits. Telemedicine visits were less likely to have video among patients who were Black, older, male, publicly insured, and from lower income areas.ConclusionsTelemedicine use, specifically with video, is significantly lower among historically vulnerable populations. Understanding barriers to telemedicine use and preferred modalities of communication among different populations will help inform insurance reimbursement and interventions at different socioecological levels to ensure the continued evolution of telemedicine is equitable.