Barriers to employment of Australian cancer survivors living with geographic or socio-economic disadvantage: A qualitative study.

BACKGROUND: Opportunities for cancer survivors' employment can both reflect and perpetuate health inequities, as employment is an important social determinant of health. Socio-economic and geographic disadvantage is associated with greater difficulty finding work, but little is known about work needs of Australian cancer survivors living with disadvantage. OBJECTIVE: This study examined survivor and health-care professional (HCP) perspectives on barriers experienced by Australian cancer survivors experiencing disadvantage when attempting to remain at or return to work. METHOD: Focus groups and individual interviews were held with cancer survivors (N = 15) and oncology and primary HCPs (N = 41), focusing on communities at risk of disadvantage. Participants were asked about employment barriers and facilitators in general and in the context of disadvantage. Themes were identified using framework analysis. RESULTS: Geographic and socio-economic disadvantage resulted in specific individual- and system-level barriers. These related to distance from treatment and support services and limited availability and suitability of work for survivors living with geographic disadvantage, and limited availability, security, and flexibility of work and previous unemployment for survivors living with socio-economic disadvantage. Identified needs included system-level changes such as public and workplace-level education, legislative and policy changes, and better access to resources. CONCLUSIONS: Cancer survivors living with disadvantage experience limited access to flexible employment opportunities and resources, further perpetuating their disadvantage. Promotion of health equity for cancer survivors living with disadvantage requires systemic changes to support attempts to remain at/return to work. PATIENT OR PUBLIC CONTRIBUTION: This study included cancer survivors and HCPs as investigators, authors and participants.

Health literacy, digital health literacy and the implementation of digital health technologies in cancer care: the need for a strategic approach.

ISSUE ADDRESSED: Digital health technologies can potentially reduce health disparities in cancer care. However, the benefits of digital health technology depend partly on users' digital health literacy, that is, "capabilities and resources required for individuals to use and benefit from digital health resources," which combines health and digital literacy. We examined issues for digital health technology implementation in cancer care regarding digital health literacy, via stakeholder consultation. METHODS: Consumers, health care professionals, researchers, developers, nongovernment and government/policy stakeholders (N = 51) participated in focus groups/interviews discussing barriers, enablers, needs and opportunities for digital health implementation in cancer care. Researchers applied framework analysis to identify themes of digital health literacy in the context of disparity and inclusion. RESULTS: Limited digital and traditional health literacy were identified as barriers to digital technology engagement, with a range of difficulties identified for older, younger and socio-economically or geographically disadvantaged groups. Digital health technology was a potential enabler of health care access and literacy, affording opportunities to increase reach and engagement. Education combined with targeted design and implementation were identified means of addressing health and digital literacy to effectively implement digital health in cancer care. CONCLUSIONS: Implementing digital health in cancer care must address the variability of digital health literacy in recipients, including groups living with disadvantage and older and younger people, in order to be effective. SO WHAT?: If cancer outcome disparity is to be reduced via digital health technologies, they must be implemented strategically to address digital health literacy needs. Health policy should reflect this approach.

Accuracy and acceptability of survivorship care plans: results of a pilot study.

Survivorship treatment summaries and care plans are increasingly incorporated into cancer care but there are limited data on their accuracy and acceptability. We have evaluated written care plans developed as part of a once-off, nurse-led survivorship consultations across four medical oncology clinics in South Australia as part of a state-wide pilot. While the accuracy of treatment summaries was high, level of detail in care plans was moderate to low, as was survivors' perception of plans' utility.

"We are becoming older women and then we have two stigmas": voicing women's biopsychosocial health issues as they age with HIV.

In April 2019, nine older women (age 50+) living with HIV in Palm Springs, California, participated in a 90-minute focus group to identify their major health issues, strengths, and HIV and aging-related health priorities. Using the rigorous and accelerated data reduction (RADaR) technique, we identified four major themes: (1) mental health, (2) HIV comorbidities, (3) social determinants of health, and (4) resiliencies. These results reinforce the need to conduct additional research focused on women aging with HIV, an understudied population that requires more effective, tailored interventions to promote better quality of life and healthy aging.

A Qualitative Evaluation of Transgender and Gender-Nonconforming Patients' Experiences in Southern California's Inland Empire.

Purpose: To evaluate negative and positive health care experiences within the racial-ethnically diverse transgender and gender-nonconforming (TGNC) community in the Inland Empire, California. Methods: Three focus groups were conducted with a racial-ethnically diverse sample of 20 TGNC-identified individuals in California's Inland Empire. The rigorous and accelerated data reduction (RADaR) technique was used to systematically analyze the qualitative data and identify salient themes. Results: Key themes included the following: a lack of TGNC cultural competency among providers, interpersonal barriers to health care, perceived systemic barriers to health care, and the effects of improper care on TGNC patients' health. Lack of cultural competency included providers' conflations of gender and sexuality and unawareness of nonbinary gender identities. Interpersonal barriers included patient experiences of being misgendered, refused treatment, and referred to by their deadnames. Perceived systemic barriers included insurance coverage, transportation issues, and a lack of expedient care. The effects of improper care were highlighted by participants seeking alternative and sometimes unsafe forms of care when timely and appropriate care was inaccessible. Conclusion: Participants recommended increasing representation of TGNC perspectives into provider trainings, involving providers in outreach with the TGNC community, and requiring letters of recommendation and certifications for providers to be deemed TGNC culturally competent as means of improving TGNC patient care.

Occult gastric cancer presenting as hypoxia from pulmonary tumor thrombotic microangiopathy.

Pulmonary tumor thrombotic microangiopathy (PTTM) causing fatal pulmonary hypertension is a rare presentation of malignancy. In general, patients with PTTM rapidly succumb to death due to severe hypoxia. To date, very few cases of PTTM have been reported in the literature; and most of these cases were from gastric cancer and were diagnosed on post mortem autopsy, as it is extremely challenging to make an ante mortem diagnosis. We here report on a case of undiagnosed diffuse gastric cancer, presenting as worsening hypoxia. The clinical, radiographic, and echocardiographic features, and laboratory and pathological results were consistent with PTTM from gastric cancer. The patient was started on anticoagulation therapy, corticosteroids, and high-flow oxygen. However, her hypoxia worsened to the extent that she required ventilator support, and she died soon after intubation due to cardiac arrest. Since diffuse gastric cancer is associated with hereditary diffuse gastric cancer syndrome, cadherin 1 gene mutation analysis was performed to estimate the risk to her daughters. The test came back negative.

Nanopore analysis: An emerging technique for studying the folding and misfolding of proteins.

Nanopore analysis is an emerging technique that enables the investigation of the conformation of a single peptide or protein molecule. Briefly, a pore is inserted into a membrane under voltage clamp conditions. When a molecule interacts with the pore there is a change in the current, I, for a time, T. Small unfolded molecules can translocate the pore whereas folded or large molecules tend to simply bump into the pore and then diffuse away. Therefore, the parameters, I and T, are dependent on the conformation of the molecule at the instant at which it encounters the pore. Thus, multiple conformations can be detected simultaneously in a single sample. As well, the analysis can be performed under dilute conditions so that folding or dimerization of a peptide can be followed in real time, which is generally difficult to study for proteins that are prone to aggregate. In this report, we describe our initial analysis of (1) Aß peptides, which are deposited as amyloid plaques in Alzheimer disease, (2) α-synuclein, which is implicated in Parkinson disease and (3) prion proteins whose misfolding is evident in transmissable spongiform encephalopathies. In each case conformational information can be obtained which may help in understanding the early steps in the misfolding pathways.

Polyostotic fibrous dysplasia in a cynomolgus Macaque (Macaca fascicularis).

A 2.3-y-old female cynomolgus macaque (Macaca fascicularis) presented with a broken right tibia and fibula. Radiographs showed multiple cyst-like defects in all long bones. We suspected that both fractures were pathologic because they occurred through these defects. Ultrasonography, MRI, and dual X-ray absorptiometry revealed that the defects were filled with soft tissue. Grossly, the bones were abnormal in shape, and a gelatinous material filled the defects and the surrounding marrow cavity. Histologically, the gelatinous material was composed of fibrin and cartilage; few normal bone cells were seen. Genetic testing revealed extra material on the short arm of chromosome 8 in all tissues examined, but no copy number alterations of likely clinical significance were observed, and no abnormalities were found that were unique to the lesions. In light of the clinical signs and radiographic and pathologic findings, polyostotic fibrous dysplasia was diagnosed. This report represents the first documented case of fibrous dysplasia in a cynomolgus macaque.