Patient and physician perspectives on treatments for low-risk prostate cancer: a qualitative study.

BACKGROUND: Patients diagnosed with low-risk prostate cancer (PCa) are confronted with a difficult decision regarding whether to undergo definitive treatment or to pursue an active surveillance protocol. This is potentially further complicated by the possibility that patients and physicians may place different value on factors that influence this decision. We conducted a qualitative investigation to better understand patient and physician perceptions of factors influencing treatment decisions for low-risk PCa. METHODS: Semi-structured interviews were conducted among 43 racially and ethnically diverse patients diagnosed with low-risk PCa, who were identified through a population-based cancer registry, and 15 physicians who were selected to represent a variety of practice settings in the Greater San Francisco Bay Area. RESULTS: Patients and physicians both described several key individual (e.g., clinical) and interpersonal (e.g., healthcare communications) factors as important for treatment decision-making. Overall, physicians' perceptions largely mirrored patients' perceptions. First, we observed differences in treatment preferences by age and stage of life. At older ages, there was a preference for less invasive options. However, at younger ages, we found varying opinions among both patients and physicians. Second, patients and physicians both described concerns about side effects including physical functioning and non-physical considerations. Third, we observed differences in expectations and the level of difficulty for clinical conversations based on information needs and resources between patients and physicians. Finally, we discovered that patients and physicians perceived patients' prior knowledge and the support of family/friends as facilitators of clinical conversations. CONCLUSIONS: Our study suggests that the gap between patient and physician perceptions on the influence of clinical and communication factors on treatment decision-making is not large. The consensus we observed points to the importance of developing relevant clinical communication roadmaps as well as high quality and accessible patient education materials.

Implementation of a novel program to support colorectal cancer screening in a community health center consortium before and after the onset of COVID-19: a qualitative study of stakeholders' perspectives.

BACKGROUND: In 2017, the San Francisco Cancer Initiative (SF CAN) established the Colorectal Cancer (CRC) Screening Program to provide technical assistance and financial support to improve CRC screening processes, and outcomes in a consortium of community health centers (CHCs) serving low-income communities in San Francisco. The purpose of this study was twofold: to evaluate the perceived influence of the support provided by the CRC Screening Program's Task Force on CRC screening processes and outcomes in these settings and to identify facilitators and barriers to SF CAN-supported CRC screening activities before and after the onset of the COVID-19 pandemic. METHODS: Semi-structured key informant interviews were conducted with consortium leaders, medical directors, quality improvement team members, and clinic screening champions. Interviews were audio-recorded, professionally transcribed, and analyzed for themes. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview questions and organize the analysis. RESULTS: Twenty-two participants were interviewed. The most commonly cited facilitators of improved screening processes included the expertise, funding, screening resources, regular follow-up, and sustained engagement with clinic leaders provided by the task force. The most salient barriers identified were patient characteristics, such as housing instability; staffing challenges, such as being understaffed and experiencing high staff turnover; and clinic-level challenges, such as lack of ability to implement and sustain formalized patient navigation strategies, and changes in clinic priorities due to the COVID-19 pandemic and other competing health care priorities. CONCLUSIONS: Implementing CRC screening programs in a consortium of CHCs is inherently challenging. Technical assistance from the Task Force was viewed positively and helped to mitigate challenges both before and during the pandemic. Future research should explore opportunities to increase the robustness of technical assistance offered by groups such as SF CAN to support cancer screening activities in CHCs serving low-income communities.

Disparities in Colorectal Cancer Screening by Time in the U.S. and Race/Ethnicity, 2010-2018.

INTRODUCTION: Longer time lived in the U.S. has been associated with worse health outcomes, especially preventable diseases, among racially and ethnically diverse groups of foreign-born individuals. This study evaluated the association between time lived in the U.S. and colorectal cancer screening adherence and whether this relationship differed by race and ethnicity. METHODS: Data from the National Health Interview Survey for 2010-2018 among adults aged 50-75 years were used. Time in the U.S. was categorized as U.S.-born, foreign-born ≥15 years, and foreign-born <15 years. Colorectal cancer screening adherence was defined according to U.S. Preventive Services Task Force guidelines. Generalized linear models with Poisson distribution were used to calculate adjusted prevalence ratios and 95% CIs. Analyses were conducted in 2020-2022, were stratified by race and ethnicity, accounted for the complex sampling design, and were weighted to be representative of the U.S. RESULTS: Prevalence of colorectal cancer screening adherence was 63% overall, 64% for U.S.-born, 55% for foreign-born ≥15 years, and 35% for foreign-born <15 years. In fully adjusted models for all individuals, only foreign-born <15 years had lower adherence than U.S.-born (foreign-born ≥15 years: prevalence ratio=0.97 [0.95, 1.00], foreign-born <15 years: prevalence ratio=0.79 [0.71, 0.88]). Results differed by race and ethnicity (p-interaction=0.002). In stratified analyses, findings for non-Hispanic White individuals (foreign-born ≥15 years: prevalence ratio=1.00 [0.96, 1.04], foreign-born <15 years: prevalence ratio=0.76 [0.58, 0.98]) and non-Hispanic Black individuals (foreign-born ≥15 years: prevalence ratio=0.94 [0.86, 1.02], foreign-born <15 years: prevalence ratio=0.61 [0.44, 0.85]) were similar to all individuals. Disparities by time in the U.S. were not observed among Hispanic/Latino individuals (foreign-born ≥15 years: prevalence ratio=0.98 [0.92, 1.04], foreign-born <15 years: prevalence ratio=0.86 [0.74, 1.01]) but persisted among Asian American/Pacific Islander individuals (foreign-born ≥15 years: prevalence ratio=0.84 [0.77, 0.93], foreign-born <15 years: prevalence ratio=0.74 [0.60, 0.93]). CONCLUSIONS: The relationship between colorectal cancer screening adherence and time in the U.S. varied by race and ethnicity. Culturally and ethnically tailored interventions are needed to improve colorectal cancer screening adherence among foreign-born people, especially among the most recently immigrated individuals.

Cancer Risk Behaviors, Cancer Beliefs, and Health Information Seeking Among Under-Represented Populations in San Francisco: Differences by Sexual Orientation and Gender Identity.

Purpose: Sexual and gender minority (SGM) individuals in the United States are at increased risk of cancer compared to the non-SGM population. Understanding how SGM persons perceive cancer risk and their practices and preferences for accessing health information is key for improving the preventive and health care services they receive. Methods: In this cross-sectional study, we analyzed data from the San Francisco Health Information National Trends Survey. SGM individuals were identified by self-report. Differences in cancer risk factors, cancer beliefs, and health information seeking were evaluated by SGM status using multivariable logistic regression models. Results: Out of 1027 participants, 130 (13%) reported being SGM individuals. Current smoking (odds ratio [OR]=1.93, 95% confidence interval [CI]=1.24-3.01) and alcohol use (OR=1.69, 95% CI=1.10-2.59) were more common among SGM persons than among non-SGM persons. No differences by SGM status were observed in health information seeking behaviors, preferences, and cancer beliefs, but SGM participants reported significantly higher odds of feeling frustrated (OR=1.78, 95% CI=1.20-2.64) and having concerns about the quality of the information (OR=1.54, 95% CI=1.03-2.31) during their most recent health information search. Conclusions: Intervention efforts aimed at SGM individuals with current use of tobacco and/or alcohol should be expanded. SGM communities also need improved access to consistent, reliable, and accurate sources of health information. Their increased frustration when seeking health information and concerns about the quality of the information they find have important implications for SGM health and care, and the drivers of these differences merit further evaluation.

Socioeconomic status and colorectal cancer screening behaviors in a vulnerable multiethnic population.

OBJECTIVE: Despite some progress in recent years, colorectal cancer (CRC) screening adherence in the United States is still suboptimal, particularly among disadvantaged groups. In this study, we assessed the association between socioeconomic status (SES) and self-reported screening non-adherence (SNA) in a sample of racial/ethnic minorities living in San Francisco, California. DESIGN/METHODS: A total of 376 participants of the San Francisco version of the Health Information National Trends Survey (SF-HINTS) with ages 50-75 years were included in this cross-sectional study. SNA was defined as not reporting blood stool test within the past year and not reporting sigmoidoscopy/colonoscopy within the past 10 years. Poisson regression models with robust variance estimators were used to evaluate the relation of SES with SNA, adjusting for measured confounders. Results are reported as prevalence ratios (PR) and 95% confidence intervals (95% CI). RESULTS: Overall SNA was 40%. In multivariable models including all respondents, retired participants had significantly lower SNA prevalence than employed participants (PR = 0.46, 95% CI = 0.26 0.83). In stratified analyses by race/ethnicity, Black respondents with less than high school (PR = 1.93, 95% CI = 1.09, 3.43) and those with high school or equivalent (PR = 1.88, 95% CI = 1.16, 3.04) had significantly higher SNA prevalence than those with at least some college. Among non-Hispanic Asian/Pacific Islanders, those disabled had significantly higher prevalence of SNA as compared to employed people (PR = 4.26, 95% CI = 2.11, 8.60). None of the SES indicators were significantly associated to SNA among Hispanics. CONCLUSIONS: Participants with lower SES characteristics were less likely to adhere to CRC screening guidelines and being retired was a predictor of compliance. There was evidence of heterogeneity in associations between SES and CRC screening by race/ethnicity. Life circumstances of retired people could provide insights for designing interventions aimed to improve CRC screening uptake in these priority groups. Future efforts should consider mechanisms underlying differences by race/ethnicity.

Impact of the Patient Protection and Affordable Care Act on 1-year survival in glioblastoma patients.

BACKGROUND: Glioblastoma (GBM) treatment requires access to complex medical services, and the Patient Protection and Affordable Care Act (ACA) sought to expand access to health care, including complex oncologic care. Whether the implementation of the ACA was subsequently associated with changes in 1-year survival in GBM is not known. METHODS: A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database. We identified patients with the primary diagnosis of GBM between 2008 and 2016. A multivariable-adjusted Cox proportional hazards model was developed using patient and clinical characteristics to determine the main outcome: the 1-year cumulative probability of death by state expansion status. RESULTS: A total of 25 784 patients and 14 355 deaths at 1 year were identified and included in the analysis, 49.7% were older than 65 at diagnosis. Overall 1-year cumulative probability of death for GBM patients in non-expansion versus expansion states did not significantly worsen over the 2 time periods (2008-2010: hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.04-1.19; 2014-2016: HR 1.18, 95% CI 1.09-1.27). In GBM patients younger than age 65 at diagnosis, there was a nonsignificant trend toward the poorer 1-year cumulative probability of death in non-expansion versus expansion states (2008-2010: HR 1.09, 95% CI 0.97-1.22; 2014-2016: HR 1.23, 95% CI 1.09-1.40). CONCLUSIONS: No differences were found over time in survival for GBM patients in expansion versus non-expansion states. Further study may reveal whether GBM patients diagnosed younger than age 65 in expansion states experienced improvements in 1-year survival.

Changes in Colorectal Cancer 5-Year Survival Disparities in California, 1997-2014.

BACKGROUND: Colorectal cancer incidence and mortality have declined with increased screening and scientific advances in treatment. However, improvement in colorectal cancer outcomes has not been equal for all groups and disparities have persisted over time. METHODS: Data from the California Cancer Registry were used to estimate changes in 5-year colorectal cancer-specific survival over three diagnostic time periods: 1997-2002, 2003-2008, and 2009-2014. Analyses included all patients in California with colorectal cancer as a first primary malignancy. Multivariable Cox proportional hazard regression models were used to evaluate the effect of race/ethnicity, insurance status, and neighborhood socioeconomic status (nSES) on 5-year colorectal cancer-specific survival. RESULTS: On the basis of a population-based sample of 197,060 colorectal cancer cases, racial/ethnic survival disparities decreased over time among non-Hispanic Blacks (NHB) compared with non-Hispanic Whites (NHW), after adjusting for demographic, clinical, and treatment characteristics. For cases diagnosed 1997-2002, colorectal cancer-specific hazard rates were higher for NHB [HR, 1.12; 95% confidence interval (CI), 1.06-1.19] and lower for Asians/Pacific Islanders (HR, 0.92; 95% CI, 0.87-0.96) and Hispanics (HR, 0.94; 95% CI, 0.90-0.99) compared with NHW. In 2009-2014, colorectal cancer-specific HR for NHB was not significantly different to the rate observed for NHW (HR, 1.03; 95% CI, 0.97-1.10). There were no changes in disparities in nSES, but increasing disparities by health insurance status. CONCLUSIONS: We found a decrease in survival disparities over time by race/ethnicity, but a persistence of disparities by neighborhood socioeconomic status and health insurance status. IMPACT: Further investigation into the drivers for these disparities can help direct policy and practice toward health equity for all groups.

Malignancies Trends in a Hispanic Cohort of HIV Persons in Puerto Rico before and after cART.

BACKGROUND: The study describes the cancer trends in a Puerto Rican Hispanic HIV/AIDS cohort for three different time periods as defined by the availability of combination antiretroviral therapy (cART) in the Island: pre (1992-1995), early (1996-2002, and recent (2003-2009). METHODS: AIDS and non-AIDS related malignancies risk, standardized incidence rate and one year mortality was evaluated in the cohort before and after cART. RESULTS: Of the 281 malignancies found in 265 persons; 72% were in men, 38% in injecting drug users and 42.3% were AIDS related cancers. AIDS related cancer standardized incidence rates decreased significantly in the cART eras; however, Kaposi's sarcoma and invasive cervical carcinoma incidence remained significantly higher in the cohort when compare to the general population. On the contrary, non-AIDS related cancer standardized incidence rates increased significantly in the cART eras, specifically those of the oral/cavity/pharynx, liver, anus, vaginal, and Hodgkin's and non-Hodgkin's Lymphomas. Around 50% of the persons with cancers were reported dead within the first year of their diagnoses without a significant variation during the cART eras. CONCLUSION: The higher incidence of Kaposi's sarcoma, invasive cervical carcinoma and non-AIDS related malignancies and their high mortality in the cART eras is suggestive of the role of oncogenic viruses, environmental agents, risky lifestyle behaviors and inadequate cancer prevention efforts that contribute and accelerate the risk of malignant transformation in these subjects. Aggressive intervention in the form of vaccines, risky practice reduction, early screening, early treatment and adequate risk reduction education needs to be incremented in this vulnerable population.

Quality of life-in patients with differentiated thyroid cancer at the general endocrinology clinics of the University Hospital of Puerto Rico.

UNLABELLED: Differentiated thyroid cancer (DTC) can compromise the quality of life of patients. Our purpose is to investigate if the quality of life, in a cohort of patients in Puerto Rico, is affected by the diagnosis and/or treatment modalities received for DTC. METHODS: This is a cross-sectional study of 75 subjects with DTC. A Spanish version of the University of Washington Quality of Life Questionnaire was used, including multiple aspects of physical and social functioning. Descriptive and bivariate analysis between domain scores and variables of interest were performed. RESULTS: 82.7% of the patients reported that their health was the same or better than it was before treatment. The mean composite score obtained was 82.3, reflecting an overall little effect on quality of life. Patients diagnosed with DTC at an age of > or =45 years reported a significantly better score on the pain domain when compared with those diagnosed earlier (p < 0.05). Patient who received >150 mCi of radioiodine had a tendency towards a worse score on the same domain (p = 0.05). CONCLUSIONS: Our cohort reported an overall minimal effect on the quality of life of patients with DTC. Future treatment strategies should include periodic quality of life evaluations, in order to tailor therapy in this growing population.

Assessing the scientific research productivity of Puerto Rican cancer researchers: bibliometric analysis from the Science Citation Index.

OBJECTIVE: The analysis of cancer scientific production in Puerto Rico is largely unexplored. The objective of this study was to characterize trends in cancer-related research publications by authors affiliated to Puerto Rican institutions in recent decades. METHODS: Manuscripts were retrieved from the Science Citation Index (SCI) database from 1982 to 2009. Search criterions were that the author's affiliation field contained some institution located in Puerto Rico and that the manuscripts were related to cancer research (according to keywords from the National Cancer Institute' cancer definition). Indexes measured in our analysis included number and type of manuscript, scientific collaboration, author's affiliation, and journal visibility. All the analyses were conducted using ProCite for bibliographic information management and STATA and SEER Joinpoint for the statistical inquiry. RESULTS: From 1982-2009, cancer-related papers authored by scientists located in Puerto Rico came to 451. Over the last three decades the scientific production underwent significant growth (APC = 6.4%, p < 0.05) with the highest peak between 2000 and 2009 (61.4% of all articles). Universities are the local institutional sector with the highest number of authors (81.4%), and the University of Puerto Rico is the most active center in this regard (68.5%). Forty-three percent of the manuscripts (n = 195) were published in 20 journals from which 14 are observed to have high visibility when compared to similar thematic journals. CONCLUSIONS: Cancer-scientific production in Puerto Rico underwent constant growth during the last three decades. A complete understanding of citing, publishing, and collaboration patterns in Puerto Rico is critical to researchers, policy makers, and health-care professionals in order to make informed decisions about cancer research priorities.