Prepregnancy Obesity Does Not Impact Placental Iron Trafficking.

BACKGROUND: Iron is critical for fetal development. Neonates of obese women may be at risk for poor iron status at birth as a result of maternal inflammation-driven overexpression of hepcidin. OBJECTIVES: The objective of this study was to determine differences in placental transfer of oral iron (57Fe) and expression of placental transferrin receptor 1 (TFR1) and ferroportin (FPN) mRNA and protein and their association with maternal and neonatal iron-related parameters, including maternal hepcidin, among women with and without prepregnancy (PP) obesity. METHODS: 57Fe ingested during the third trimester of pregnancy was recovered in venous umbilical cord blood among 20 PP obese [BMI (in kg/m2): 30.5-43.9] and 22 nonobese (BMI: 18.5-29.0) women aged 17-39 y. Placental TFR1 and FPN mRNA and protein expression were quantified via qPCR and Western blot. Maternal and neonatal markers of iron status and regulation, as well as inflammation, were measured. Descriptive and inferential statistical tests (e.g., Student t test, Pearson correlation) were used for data analysis. RESULTS: There was no difference in cord blood enrichment of 57Fe or placental mRNA or protein expression of TFR1 or FPN among the women with and without PP obesity. Maternal hepcidin was not correlated with cord blood enrichment of 57Fe or placental FPN mRNA or protein expression. Maternal log ferritin (corrected for inflammation) was inversely correlated with log percent enrichment of 57Fe in cord blood (partial r = -0.50; P < 0.01, controlled for marital status) and protein expression of TFR1 (r = -0.43; P = 0.01). CONCLUSIONS: Placental iron trafficking did not differ among women with and without PP obesity. Findings reinforce the importance of maternal iron stores in regulating placental iron trafficking.

Psychometric properties of the Korean version of the Pittsburgh Fatigability Scale in breast cancer survivors.

BACKGROUND: Fatigability has recently emerged in oncology as a concept that anchors patients' perceptions of fatigue to defined activities of specified duration and intensity. This study aimed to examine the psychometric properties of the Korean version of the Pittsburgh Fatigability Scale (K-PFS) for women with breast cancer. METHODS: This cross-sectional study involved 196 women with breast cancer recruited from a tertiary hospital in Seoul, Korea. Reliability was evaluated using Cronbach's alpha, and confirmatory factor analysis was conducted to examine the factor structure of the K-PFS. Four goodness-of-fit values were evaluated: (1) the comparative fit index (CFI), (2) the Tucker-Lewis index (TLI), (3) the root mean square error of approximation (RMSEA), and (4) the standardized root mean square residual (SRMR). RESULTS: Of the 196 survivors, 71.1% had greater physical fatigability (K-PFS Physical score ≥ 15) and 52.6% had greater mental fatigability (K-PFS Mental score ≥ 13). The Cronbach's alpha coefficient for the total K-PFS scale was 0.926, and the coefficients for the physical and mental fatigability domains were 0.870 and 0.864, respectively. In the confirmatory factor analysis for physical fatigability, the SRMR value (0.076) supported goodness of fit, but other model fit statistics did not (CFI = 0.888, TLI = 0.826, and RMSEA = 0.224). For mental fatigability, although three goodness-of-fit values were acceptable (CFI = 0.948, TLI = 0.919, and SRMR = 0.057), the RMSEA value (0.149) did not indicate good model fit. However, each item coefficient was statistically significant (> 0.5), and the K-PFS was therefore found to be valid from a theoretical perspective. CONCLUSION: This study provides meaningful information on the reliability and validity of the K-PFS instrument, which was developed to meet an important need in the context of breast cancer survivors. Additional research should examine its test-retest reliability and construct validity with performance measures.

Comparing the roles of social context, networks, and perceived social functioning with health-related quality of life among self-reported rural female cancer survivors.

PURPOSE: Rural women, compared to urban, experience worse survivorship outcomes, including poorer health-related quality of life (QOL). There is a need to characterize the role of multilevel social factors that contribute to QOL, including context, networks, and functioning. Our objectives were to (1) use latent class analysis to identify distinct classes of social context and social networks and (2) examine how multilevel social factors (context, networks, and functioning) are associated with health-related QOL. METHODS: We recruited self-identified rural survivors to the Illinois Rural Cancer Assessment (2017-2018), via community-based sampling methods, and participants completed the survey online, by phone, or on paper. We used latent class analysis to generate multidimensional variables for contextual and network factors. We next modeled each social factor sas a predictor in separate, bivariable linear regressions for the QOL outcomes, followed by multivariable, adjusted regressions. RESULTS: For our first objective, there were three classes each of county-level contexts (1, highly rural, socioeconomically disadvantaged, and mostly lacking in cancer-related services; 2, mostly rural, moderately disadvantaged, and underserved; 3, mostly metropolitan, less disadvantaged, and most-resourced) and social networks (1, no caregivers; 2, only spousal caregivers with whom they communicated daily; 3, multiple caregivers with varying daily communication). For our second objective, among all social factors, only functioning was associated with better mental health-related QOL. No factors were associated with physical health-related QOL. CONCLUSIONS: Our findings suggest a rich diversity of social context and networks among rural female cancer survivors, and social functioning is particularly important for mental health-related QOL.

Assessing the relationship between patient-provider communication quality and quality of life among rural cancer survivors.

PURPOSE: We explored relationships between patient-provider communication quality (PPCQ) and three quality of life (QOL) domains among self-identified rural cancer survivors: social well-being, functional well-being, and physical well-being. We hypothesized that high PPCQ would be associated with greater social and functional well-being, but be less associated with physical well-being, due to different theoretical mechanisms. METHODS: All data were derived from the 2017-2018 Illinois Rural Cancer Assessment (IRCA). To measure PPCQ and QOL domains, we respectively used a dichotomous measure from the Medical Expenditure Panel Survey's Experience Cancer care tool (high, low/medium) and continuous measures from the Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS: Our sample of 139 participants was largely female, non-Hispanic White, married, and economically advantaged. After adjusting for demographic and clinical variables, patients who reported high PPCQ exhibited greater social well-being (Std. ß = 0.20, 95% CI: 0.03, 0.35, p = 0.02) and functional well-being (Std. ß = 0.20, 95% CI: 0.05, 0.35, p = 0.03) than patients with low/medium PPCQ. No association was observed between PPCQ and physical well-being (Std. ß = 0.06, 95% CI: - 2.51, 0.21, p = 0.41). Sensitivity analyses found similar, albeit attenuated, patterns. CONCLUSION: Our findings aligned with our hypotheses. Future researchers should explore potential mechanisms underlying these differential associations. Specifically, PPCQ may be associated with social and functional well-being through interpersonal mechanisms, but may not be as associated with physical well-being due to multiple contextual factor rural survivors disproportionately face (e.g., limited healthcare access, economic hardship) and stronger associations with clinical factors.

Race and Gender Differences in Awareness of Colorectal Cancer Screening Tests and Guidelines Among Recently Diagnosed Colon Cancer Patients in an Urban Setting.

The purpose of this study was to first characterize the prevalence of recall, recognition, and knowledge of colon cancer screening tests and guidelines (collectively, "awareness") among non-Hispanic black (NHB) and NH white (NHW) urban colon cancer patients. Second, we sought to examine whether awareness was associated with mode of cancer detection. Low awareness regarding colon cancer screening tests and guidelines may explain low screening rates and high prevalence of symptomatic detection. We examined recall, recognition, and knowledge of colorectal cancer (CRC) screening tests and guidelines and their associations with mode of cancer detection (symptomatic versus screen-detected) in 374 newly diagnosed NHB and NHW patients aged 45-79. Patients were asked to name or describe any test to screen for colon cancer (recall); next, they were given descriptions of stool testing and colonoscopy and asked if they recognized each test (recognition). Lastly, patients were asked if they knew the screening guidelines (knowledge). Overall, awareness of CRC screening guidelines was low; just 20% and 13% of patients knew colonoscopy and fecal test guidelines, respectively. Awareness of CRC screening tests and guidelines was especially low among NHB males, socioeconomically disadvantaged individuals, and those diagnosed at public healthcare facilities. Inability to name or recall a single test was associated with reduced screen-detected cancer compared with recall of at least one test (36% vs. 22%, p = 0.01). Low awareness of CRC screening tests is a risk factor for symptomatic detection of colon cancer.

Prepregnancy Obesity Is Not Associated with Iron Utilization during the Third Trimester.

BACKGROUND: An adequate maternal iron supply is crucial for maternal red blood cell (RBC) expansion, placental and fetal growth, and fetal brain development. Obese women may be at risk for poor iron status in pregnancy due to proinflammatory-driven overexpression of hepcidin leading to decreased iron bioavailability. OBJECTIVE: The objective of this study was to determine the impact of prepregnancy (PP) obesity on third-trimester maternal iron utilization. DESIGN: Using the stable isotope 57Fe, we measured iron utilization in the third trimester in PP obese [BMI (in kg/m2): ≥30] and nonobese (BMI: 18.5-29.9) women. We also assessed iron status, hepcidin, inflammation, erythropoietin, dietary iron intake, and gestational weight gain. Descriptive and inferential statistical tests (e.g., Student t test, Pearson correlation) were used for data analysis. RESULTS: Fifty pregnant women (21 PP obese, 29 PP nonobese) were included. Mean age was 27.6 ± 6.8 y and mean gestational age at time of 57Fe administration was 32.7 ± 0.7 wk. Anemia (hemoglobin <11 g/dL for non-black and <10.2 g/dL for black women) affected 38% of women (43% PP obese compared with 35% PP nonobese; P = 0.55). Women with PP obesity had significantly higher C-reactive protein (8.5 compared with 3.4 mg/L, P = 0.0007) and total body iron corrected for inflammation (6.0 compared with 4.3 mg/kg, P = 0.04) compared with the nonobese women. There was no difference in serum hepcidin or iron utilization between the PP BMI groups. CONCLUSION: This is the first study to assess the impact of PP obesity on maternal iron utilization. We found no difference in iron utilization in the third trimester of pregnancy in women with and without PP obesity. Despite higher frequency of anemia, women with PP obesity had less depleted body iron stores, suggesting some degree of iron sequestration. This finding should be followed up and extended to understand effects on fetal iron bioavailability.

Comorbidities, treatment-related consequences, and health-related quality of life among rural cancer survivors.

PURPOSE: We explored how lifetime comorbidities and treatment-related cancer symptoms were associated with quality of life (QOL) in rural cancer survivors. METHODS: Survivors (n = 125) who were rural Illinois residents aged 18+ years old were recruited from January 2017 to September 2018. We conducted 4 multivariable regressions with QOL domains as outcomes (social well-being, functional well-being, mental health-MHQOL, physical health-PHQOL); the number of physical and psychological comorbidities (e.g., arthritis, high blood pressure, stroke) and treatment-related cancer symptoms (e.g., worrying, feeling sad, lack of appetite, lack of energy) as predictors; and, cancer-related and demographic factors related to these variables as covariates. RESULTS: The number of comorbidities and number of treatment-related symptoms were inversely associated with functional well-being (Std ß = - 0.36, p < 0.0001 and - 0.18, p = 0.03), and MHQOL (Std ß = - 0.30, p = 0.001 and Std ß = - 0.25, p = 0.004). Comorbidities were associated inversely with social well-being (Std ß = - 0.27, p = .003). Comorbidities and treatment-related symptoms were not associated with PHQOL (p = 0.20-0.24). Sensitivity analyses suggested that psychological comorbidities, treatment-related psychological symptoms, and physical comorbidities were associated with social well-being, functional well-being, and MHQOL. CONCLUSIONS: Our study highlights the utility of risk-based survivorship care plans to address the negative, additive impact of comorbidities and the treatment-related symptoms to improve the health-related QOL among rural survivors. Future research should assess how contextual factors (e.g., geographic distance to oncologists and other providers) should be incorporated in survivorship care planning and implementation for rural survivors.

Reliability and validity of the Japanese version of the Quality of Life Index for patients with cancer.

This study was designed to evaluate the psychometric properties of the newly completed Japanese translation of the Ferrans and Powers Quality of Life Index Cancer Version III (QLI). Using a cross-sectional descriptive design, 136 ambulatory patients with gastrointestinal cancer (55 receiving chemotherapy, 76 with stable health status after treatment, and five status not known) completed a questionnaire at a one-time point, and 26 patients (stable health status) completed the questionnaire again 2 weeks later. Internal consistency reliability was supported by Cronbach's α of .96 for the total scale, with subscales ranging from .83 to .93. A test-retest correlation of 0.76 (total scale) provided evidence of stability reliability over a 2-week period, with subscale retest correlations ranging from 0.70 to 0.83. Confirmatory factor analysis showed the same four domains for the Japanese translation as the original QLI, supporting construct validity. We also assessed construct validity by examining the relationships between the Japanese QLI and six other concepts known to be related to the quality of life. As hypothesized, all correlations were moderate and in the expected direction (pain -0.39, anxiety -0.54, depression -0.63, stress -0.51, pain interfering with functioning -0.52, and general health 0.62). This evidence of the reliability and validity of the Japanese translation of the QLI supports its use in research and clinical practice to evaluate the impact of cancer and treatment. This new translation can be used to assess the patient's perspective of their quality of life, both within Japan and in cross-cultural studies with the QLI in other languages.

Cultural beliefs about breast cancer in Vietnamese women.

BACKGROUND: This study examined factors influencing cultural beliefs associated with later-stage detection of breast cancer and determined what factors influence those cultural beliefs in Vietnamese women residing in a rural Vietnamese community. METHODS: A cross-sectional survey was conducted with 289 women aged 20-64 years from 12 villages using a self-administered structured questionnaire. Cultural beliefs were measured with a 13-item cultural beliefs scale consisting of four domains-characteristics of breast lumps, self-help techniques, faith-based beliefs, and futility of treatment. Data were collected in February 2017 and analyzed using chi-square tests, nonparametric tests, Fisher's exact tests, and multiple linear regression analyses with SPSS/WIN 24.0 statistical software. RESULTS: Although the total score was relatively low (3.4 out of 13), cultural beliefs that could contribute to later-stage breast cancer were identified. Younger women (ß = .15, p = .016) and women with a lower income (ß = .21, p < .001) held more erroneous cultural beliefs as compared to their counterparts. Most women believed they would not get breast cancer if they took care of themselves. More than one-third held cultural beliefs about breast lumps, thinking they would need to be painful and/or actively growing to be breast cancer. CONCLUSIONS: The results support the urgent need for education concerning breast cancer health promotion, including breast cancer assessment as well as guidance on evidence-based and up-to-date detection measures to change rural Vietnamese women's cultural beliefs.

Nurses' roles and challenges in providing end-of-life care in neonatal intensive care units in South Korea.

BACKGROUND: Neonatal Intensive Care Unit (NICU) nurses in Korea often experience challenges in providing care for dying infants and their families. However, there is limited understanding about what contributes to the challenges related to end-of-life care. PURPOSE: To describe NICU nurses' perceived roles and challenges faced while providing end-of-life care in South Korea. METHODS: A qualitative descriptive study was conducted with 20 NICU nurses in South Korea using semi-structured interviews. Participants were recruited from two NICUs in Seoul, where infant mortality is the highest in South Korea. Transcribed interviews were coded by two research personnel, and subsequently, a developed coding book was translated by three research personnel. The codes developed were categorized and peer-reviewed to develop themes using conventional content analysis. RESULTS: Nurses' roles during end-of-life care were grouped into four categories: providing information and support, enhancing attachment between the parents and infants, providing direct care to the infant, and completing documentation. Nurses' perceived challenges during end-of-life care included providing end-of-life care without adequate experience and knowledge, environmental constraints on end-of-life care, and conflicted situations during end-of-life care. CONCLUSION: Although the nurses provided the best care they could, their end-of-life care practice was hindered for various reasons. To enhance NICU nurses' ability to provide and make them more capable of providing high quality EOL care, hospitals need to support nurse education and improve staffing level, and create in NICUs an environment that is favorable for providing EOL care.

Factors affecting trust in healthcare among middle-aged to older Korean American women.

BACKGROUND: Predictors of trust in healthcare providers and the healthcare system have never been studied in Korean Americans (KA) despite the fact that trust plays an important role in health behaviors. The purpose of this study is to examine factors influencing trust in the healthcare system and providers among KA women. METHODS: Data were collected in 196 KA women examining the effects of perceived discrimination and trust on breast cancer screening in the Chicago metropolitan area. Path analysis was used to identify factors influencing trust in the healthcare system and providers. RESULTS: Acculturation was positively related to trust in healthcare providers (ß = .15, p =. 002), and discrimination in the healthcare system was inversely related to trust in healthcare providers (ß = -.60, p <. 001). Length of stay in the US was inversely related to distrust in the healthcare system (ß = -.14, p <. 001), and discrimination in healthcare was positively related to distrust in the healthcare system (ß = .60, p <. 001). Trust in healthcare providers and distrust in the healthcare system were moderately correlated (r = .51, p < .001). CONCLUSION: Higher levels of acculturation and lower levels of perceived discrimination were identified as predictors of higher levels of trust in healthcare providers. A shorter stay in the US and higher levels of discrimination were identified as predictors of higher levels of distrust in the healthcare system. Perceived discrimination is a target for interventions to enhance trust in the healthcare system, and therefore reduce healthcare disparities in KAs.

Health Volunteerism and Improved Cancer Health for Latina and African American Women and Their Social Networks: Potential Mechanisms.

Health volunteerism has been associated with positive health outcomes for volunteers and the communities they serve. This work suggests that there may be an added value to providing underserved populations with information and skills to be agents of change. The current study is a first step toward testing this hypothesis. The purpose is to identify how volunteerism may result in improved cancer health among Latina and African American women volunteers. A purposive sample of 40 Latina and African American female adults who had participated in cancer volunteerism in the past 5 years was recruited by community advocates and flyers distributed throughout community venues in San Diego, CA. This qualitative study included semi-structured focus groups. Participants indicated that volunteerism not only improved their health but also the health of their family and friends. Such perceptions aligned with the high rates of self-report lifetime cancer screening rates among age-eligible patients (e.g., 83-93 % breast; 90-93 % cervical; 79-92 % colorectal). Identified mechanisms included exposure to evidence-based information, health-protective social norms and support, and pressure to be a healthy role model. Our findings suggest that train-the-trainer and volunteer-driven interventions may have unintended health-protective effects for participating staff, especially Latina and African American women.

Evaluation of fatigability measurement: Integrative review.

Fatigability is defined as the extent of fatigue in the context of activity and differs from the term used in exercise literature to describe muscle endurance characteristics. Many fatigability measures are available, but no studies have thoroughly evaluated them for adequate incorporation of fatigability concepts. This integrative review provides an overall assessment of existing fatigability measures and then evaluates each in depth. A database search and hand search produced 14 studies for review. Fatigability measurement took three forms: self-reported fatigability, perceived fatigability (self-reported fatigue following a defined performance test), and performance fatigability (performance deterioration). Of 17 measures identified, validity and/or reliability was reported for six (35.3%), and no measure was used in more than one study. Fatigability measures have been correlated with clinical measures, indicating that fatigability should be measured during routine clinical health screening. Refinement of measures and additional fatigability data collection will improve understanding and treatment of fatigue.

Changes in the racial disparity in breast cancer mortality in the ten US cities with the largest African American populations from 1999 to 2013: The reduction in breast cancer mortality disparity in Chicago.

PURPOSE: Assess progress made to reduce racial disparity in breast cancer mortality in Chicago compared to nine other cities with largest African American populations and the US. METHODS: The Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) female breast cancer mortality rates and rate ratios (RR) (disparity) were compared between 1999 and 2005 and 2006 and 2013. RESULTS: Between the two periods, the NHB breast cancer mortality rate in Chicago decreased by 13.9% (95% CI [-13.81, -13.92] compared to 7.7% (95% CI [-7.52, -7.83]) for NHW. A drop of 20% in the disparity was observed, from 51% (RR: 1.51, 95% CI [-7.52, -7.83]) to 41% (RR: 1.41, 95% CI [1.30, 1.52]). Whereas from 1999 to 2005 Chicago's disparity was above that of the U.S., from 2006 to 2013, it is now slightly lower. For the remaining nine cities and the US, the mortality disparity either grew or remained the same. CONCLUSIONS: Chicago's improvement in NHB breast cancer mortality and disparity reduction occurred in the context of city-wide comprehensive public health initiatives and shows promise as a model for other cities with high health outcome disparities.

Negative psychological consequences of breast cancer among recently diagnosed ethnically diverse women.

OBJECTIVE: Breast cancer has psychological consequences that impact quality of life. We examined factors associated with negative psychological consequences of a breast cancer diagnosis, in a diverse sample of 910 recently diagnosed patients (378 African American, 372 white, and 160 Latina). METHODS: Patients completed an in-person interview as part of the Breast Cancer Care in Chicago study within an average of 4 months from diagnosis. The Cockburn negative psychological consequences of breast cancer screening scale was revised to focus on a breast cancer diagnosis. Path analysis assessed predictors of psychological consequences and potential mediators between race/ethnicity and psychological consequences. RESULTS: Compared to white counterparts, bivariate analysis showed African American (ß = 1.4, P < .05) and Latina (ß = 3.6, P < .001) women reported greater psychological consequences. Strongest predictors (P < .05 for all) included unmet social support (ß = .38), and provider trust (ß = .12), followed by stage at diagnosis (ß = .10) and perceived neighborhood social disorder (ß = .09).The strongest mediator between race/ethnicity and psychological consequences was unmet social support. CONCLUSIONS: African American and Latina women reported greater psychological consequences related to their breast cancer diagnosis; this disparity was mediated by differences in unmet social support. Social support represents a promising point of intervention.

Breast cancer delay in Latinas: the role of cultural beliefs and acculturation.

Cultural beliefs about breast cancer may act as a barrier to Latina women seeking preventive services or timely follow-up for breast symptoms regardless of access. This study examines the association between factors and breast cancer cultural beliefs and the extent to which cultural beliefs are associated with delays in breast cancer care. Participants who were Latina, ages 30-79, and had been diagnosed with a primary breast cancer were examined (n = 181). Interviews included a 15-item cultural beliefs scale spanning beliefs inconsistent with motivation to seek timely healthcare. Self-reported date of symptom discovery, date of first medical presentation, and date of first treatment were used to construct measures of prolonged patient, clinical, and total delay. Logistic regression with model-based standardization was used to estimate crude and confounder-adjusted prevalence differences for prolonged delay by number of cultural beliefs held. Women held a mean score of three cultural beliefs. The belief most commonly held was, "Faith in God can protect you from breast cancer" (48 %). Holding three or more cultural beliefs was associated with lower acculturation, lower socioeconomic status and less access to care (p < 0.01). After adjusting for age, education, income, acculturation, trust, and insurance, likelihood of prolonged total delay remained 21 percentage points higher in women who held a higher number cultural beliefs (p = 0.02). Cultural beliefs may predispose Latina women to prolong delays in seeking diagnosis and treatment for breast symptoms. Cultural beliefs represent a potential point of intervention to decrease delays among Latina breast cancer patients.

Health Behavior Adherence in a Metropolitan-Based Metabolic Syndrome Management Program during the COVID-19 Pandemic.

Background: The COVID-19 pandemic increased the worldwide prevalence of metabolic syndrome. The purpose of this study was to assess health behavior adherence during the pandemic in adults who had engaged in a metabolic syndrome management program for at least 6 months. This assessment included an evaluation of health behavior changes, factors influencing adherence, and clinical parameters. The city-wide program was operated by the Seoul Metropolitan Government. Methods: Baseline and follow-up data were compared in 116 participants who engaged in the program for at least 6 months prior to the pandemic. Health behaviors and clinical parameters were examined. Generalized estimating equation analysis was used to identify sociodemographic variables influencing health behavior adherence over time. Results: Systolic blood pressure, waist circumference, and blood glucose improved (all P<0.05), and risk factors decreased (P<0.001) from baseline to follow-up (mean±standard deviation, 1.13±0.91 years). All six health behaviors, physical activity and weight control, eating habits, alcohol consumption and smoking, stress management, sleep and rest, and medication compliance and medical examination improved (all P<0.001) from baseline to follow-up (2.37±1.05 years). Smoking and employment negatively influenced adherence to health behaviors (P<0.05). Participants felt the most beneficial part of the program was receiving sequential medical examination results with follow-up consultations by public health professionals without charge. Conclusion: Our study demonstrated the durability of the impact of the Seoul Program on all six targeted health behaviors as well as clinical parameters. Findings encourage participation in such broad-based programs and development of novel approaches to facilitate success for smokers and employed participants.

Act or Wait? Presentation Delay in Symptomatic Breast Cancer in China.

BACKGROUND: In Western countries, factors contributing to breast cancer presentation delay have been identified, but little is known about presentation delay in China, where culture and healthcare systems are quite different. OBJECTIVE: To describe the delay interval among newly diagnosed breast cancer patients in China and to identify factors influencing delay, including the COVID-19 pandemic. METHODS: Using a cross-sectional design, we recruited 154 participants within 3 months of pathological diagnosis of breast cancer. Data were collected using standardized scales and open-ended questions. RESULTS: We found 44.8% of participants delayed ≥1 month, and 24.7% delayed ≥3 months before presentation, after self-discovery of symptoms. Logistic regression analysis showed that factors associated with longer delay (≥1 month) included preferring female physicians for breast examination, fewer negative emotions (afraid, anxious, distressed) regarding breast symptoms, more competing priorities, believing folk therapy can help treat lumps, and visiting a secondary or tertiary hospital instead of primary healthcare providers (P < .05 for all). Interaction tests showed perceived seriousness of symptoms significantly predicted delay of ≥1 month only when perceived healthcare access or trust in physicians was low. Patients (14%) reported delaying due to fear of COVID-19 infection and inability to leave home. CONCLUSIONS: Presentation delays were substantial and multilevel barriers to timely presentation were identified, which would be expected to contribute to later-stage cancer at diagnosis. IMPLICATIONS FOR PRACTICE: Findings suggest that nursing interventions and improved health policies are urgently needed in China, including breast cancer education to increase awareness.

Barriers to Surveillance Mammography Adherence in Korean Breast Cancer Survivors.

OBJECTIVES: To identify barriers to surveillance mammography adherence in Korean breast cancer survivors (BCSs), which is crucial for early detection of recurrence and new cancers. SAMPLE & SETTING: 195 BCSs were recruited from a breast cancer clinic and its support groups at a South Korean hospital. METHODS & VARIABLES: This descriptive study used a cross-sectional design. Participants completed a self-administered multi-instrument survey based on a comprehensive framework for adherence, including individual characteristics, symptoms, quality of life, cognitive appraisal, social support, and healthcare system factors. RESULTS: Having had a mammogram within the past year was considered adherent (n = 177), and no mammography within the past year was considered nonadherent (n = 18). Logistic regression revealed that longer time since diagnosis (p < 0.001), greater depression (p = 0.024), and higher health services utilization (p < 0.001) were predictors of lower mammography adherence (chi square = 76.618, p < 0.001, R2 = 58%). IMPLICATIONS FOR NURSING: This is the first study to identify depression as a barrier to surveillance mammography in BCSs, suggesting that depression screening and treatment may be important for increasing adherence.

Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines.

Conflicting study results with regards to racial/ethnic disparities in chemotherapy use among breast cancer patients may be due to the different sample populations, treatment data sources, and treatment eligibility definitions used. This study examined chemotherapy disparity in the context of changing treatment guidelines and explored factors that may help explain treatment differences observed. The data come from a population-based study that included interview and medical record data (including state cancer registry) from non-Hispanic (nH) White, nH Black, and Hispanic breast cancer patients diagnosed in 2005-2008. Logistic regression using model-based standardization was used to estimate age-adjusted risk differences and multivariate analysis was conducted to identify explanatory factors of the differences. Per the 2005/2006 National Comprehensive Cancer Network (NCCN) guidelines, minority patients appeared more likely than nH White patients to receive a chemotherapy recommendation (0.87 vs 0.75, p = 0.003). When eligibility was determined per the 2007 guidelines, there was no disparity because under these guidelines, nH White patients were more likely than minority patients to have tumors that no longer required chemotherapy. There was evidence that chemotherapy advances for breast cancer patients are implemented in the clinical setting well ahead of NCCN guidelines. Finally, among eligible patients, chemotherapy recommendation was very high and virtually always accepted and received, with no disparities found at these points of clinical care. The findings suggest that an evaluation of guideline-adherent chemotherapy treatment patterns must carefully consider the definition of treatment eligibility, given ongoing changes in treatment guidelines and early uptake of new diagnostic tools and treatments.