Cancer Education Research Articles

Abstract 1003: Contact registry for health-related cancer research: Promoting inclusion in research

Abstract Contact Registries can serve as key tools in connecting community members to cancer health research opportunities. Members of underrepresented groups who enroll in a contact registry can choose to participate in studies they find interesting, provided they are an ideal candidate for participation. However, limited information exists regarding the types of studies underrepresented groups would want to participate in. The Florida-California Cancer Research, Education, and Engagement (CaRE2) Health Equity Center Community Outreach Core (COC) created a contact registry of community members self-identifying as Black/African American (B/AA) and/or Hispanic/Latinx (H/L) persons who are interested in learning about future research studies conducted at CaRE2 institutions. The CaRE2 Contact Registry was implemented in August 2022 by the CaRE2 COC, one of the six (6) key cores within the CaRE2 Center. COC’s primary objective is to increase the number of persons participating in cancer research, which ultimately produces findings more applicable to the broader, diverse population of B/AA and H/L communities in both Florida and California. Our study team promotes the registry at local community events and through our center’s social media accounts and website (https://care2healthequitycenter.org/the-care2-contact-registry/). Recruitment consists of both in-person and online methods provided in both Spanish and English with data stored on REDCap, an online data repository system. For in-person enrollment, a consent/authorization form and OPT-IN survey are completed; meanwhile, our online recruitment requires additional screening to ensure eligibility. Eligibility requires that the person resides in 1) either California or Florida, 2) be 18+ years old, and 3) identify as B/AA or H/L. In addition to collecting contact and demographic information, participants can choose their research study interests. For example, they can choose to participate in surveys, community forums, focus groups, a cancer advocacy training program, and/or to provide a hair, saliva, or blood sample. A $10.00 gift card, either in a physical or electronic format, was provided to each confirmed enrollee. As of November 13, 2023, 1,269 persons have enrolled, representing 63% of the 2,000 enrollment goal. While 92% of registry enrollees are willing to participate in health research involving surveys, only 20% are willing to participate in health research studies requiring saliva (23%), hair (22%), or blood (20%) donations. In conclusion, registry enrollees, regardless of race or ethnicity, have a high interest in participating in studies involving completing surveys or attending focus groups. However, efforts must continue to increase participation willingness for research involving biospecimen donation. Future efforts will also include connecting enrollees to cancer health-related research studies of their interest. Citation Format: Fern Webb, IIeana Guzman, Brooke Hensel, Eduardo Ibarra, Carolina Aristizabal, John Luque, Rosa Barahona, Diana Wilkie, Mariana C. Stern, Lourdes Baezconde-Garbanati, Sandra Suther. Contact registry for health-related cancer research: Promoting inclusion in research [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1003.

Abstract 1292: ProTALKS: A community outreach project founded by a graduate of the CaRE2 Community Scientist Research Advocacy training program, Mrs. Lynn Jones-Turpin

Abstract ProTALKS was created and led by a community member committed to reducing prostate cancer health disparities. ProTALKS stands for Prostate Cancer Outreach, Opinions, and Opportunities and is designed to increase awareness of prostate cancer prevention, research, and treatment as well as highlight the health disparities observed in Black communities. According to the Florida Department of Health, prostate cancer incidence and mortality rates among Black men living in Duval County are higher compared to men of other races and ethnicities. Therefore, there is a need for programs like ProTALKS that focus on early detection strategies and promoting community resources. In collaboration with the Prostate Health Education Network (PHEN), The American Legion Post 197, and Florida Blue, ProTALKS has increased access to services such as prostate cancer screening and evidence-based information. Community events implemented by ProTALKS bring together oncologists, researchers, key community leaders, health educators, and providers to educate and promote positive health behavior changes among high-risk communities. In addition to hosting health fairs, ProTalks has hosted grilling competitions and community awareness walks to further educate the community about prostate cancer prevention, screening, and research. ProTALKS also shares information through the local newspaper, The Jacksonville Free Press, The Lynn & Friends radio show, and social media platforms. Since its start in 2021, with support from the Florida-California Cancer Research, Education, and Engagement (CaRE2) Health Equity Center, ProTALKS has implemented more than 10 community events with over 1,000 community members from Jacksonville, Florida. ProTALKS, in collaboration with CaRE2, continues to disseminate information about cancer screening, the importance of clinical trial participation, and donating biospecimens for cancer research. Although ProTALKS has been successful in its mission, there have been challenges throughout its implementation. For example, one challenge has been increasing the number of community members attending events and using appropriate marketing techniques to promote ProTALKS’ activities. Future implications to avoid challenges include recruiting more volunteers, and partnering with other community organizations in Duval County. Citation Format: Lynn Jones-Turpin, Ileana Guzman, Brooke Hensel, Fern Webb. ProTALKS: A community outreach project founded by a graduate of the CaRE2 Community Scientist Research Advocacy training program, Mrs. Lynn Jones-Turpin [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1292.

Abstract 3472: Tailored cancer outreach efforts of a community outreach core working with Native Hawaiian and Pacific Islanders in Hawaiʻi

Abstract Background The Community Outreach Core (COC) of the Pacific Island Partnership for Cancer Health Equity (PIPCHE) aims to improve health equity for historically underserved populations including Native Hawaiians and other Pacific Islanders (NHOPIs), and Filipinos. PIPCHE is a partnership between the University of Hawai’i Cancer Center and the University of Guam whose efforts are focused in Hawaiʻi, Guam and the U.S. Affiliated Pacific Islands (USAPI). The COC directly addresses the disproportionately high rates of health disparities and cancer incidence and mortality found within NHOPIs often due to multiple complex historical, social, cultural, and environmental factors. Cancer is the second leading cause of death in Hawai’i between 2014-2018, as well as the second most common cause of death in nearly all USAPI jurisdictions. The COC uses research-tested, community-engaged approaches to modify determinants of cancer in these groups. Methods Outreach efforts have addressed NHOPI cancer inequities by raising awareness of high cancer burdens experienced by these underserved communities. Efforts include resource sharing and data collection at various venues in Hawaiʻi such as health/wellness fairs, public housing, and Pacific Islander churches. Outreach Advisory Council meetings were held biannually with community health leaders to discuss ongoing and future initiatives/resource sharing. The COC provided health providers and students with cultural competency training on more efficient strategies to work with these unique NHOPI groups. The COC provided presentations and short talks across the U.S, including a Health Providers Symposium on lung cancer across the Pacific. Outreach efforts have included tailored NCI-based Screen to Save (S2S) colorectal cancer education to NHOPIs. Results Forty-seven major outreach events were conducted from 2021 to November 2023. These include: 1 Health Providers’ Cancer Symposium, 5 Outreach Advisory Council meetings, 5 Cultural Competency trainings and class lectures, 11 conference/community and short talk presentations, and 25 community outreach events. There were 1,900 attendees reached during these regional and national outreach activities. The COC works with professional audiences at the national level to inform these groups about cancer and the health burdens of NHOPIs. A total of 97 Pacific Islanders received the S2S education and completed a pre-posttest with positive increases in means found for all 14 questions. Conclusion The PIPCHE COC has been able to reach NHOPIs though community partnerships to deliver culturally tailored cancer prevention education and efforts within Hawaiʻi, as well as shed light nationally of the cancer burdens these populations face. The S2S education has been able to raise awareness of cancer screenings and holds promise as a potential strategy to address cancer burdens of NHOPI communities. Citation Format: Mark Lee Willingham Jr., Kevin D. Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Antoinette Kleiner, Angelina Mummert. Tailored cancer outreach efforts of a community outreach core working with Native Hawaiian and Pacific Islanders in Hawaiʻi [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3472.

Institution-Wide Retreats Foster Organizational Learning and Action at a Comprehensive Cancer Center

Providing safe and informed healthcare for sexual and gender minority (SGM) individuals with cancer is stymied by the lack of sexual orientation and gender identity (SOGI) data reliably available in health records and by insufficient training for staff. Approaches that support institutional learning, especially around sensitive topics, are essential for hospitals seeking to improve practices impacting patient safety and research. We engineered annual institutional retreats to identify and unify stakeholders, promote awareness of gaps and needs, identify initiatives, minimize redundant projects, and coordinate efforts that promote improvements in SGM cancer care, education, and research. The 2022 and 2023 retreats employed a 4-h hybrid format allowing virtual and in-person engagement. Retreat organizers facilitated small-group discussions for brainstorming among participants. We performed descriptive statistics from retreat evaluations. The retreats engaged 104 attendees from distinct departments and roles. Participants expressed robust satisfaction, commending the retreat organization and content quality. Notably, the first retreat yielded leadership endorsement and funding for a Quality Improvement pilot to standardize SOGI data collection and clinical staff training. The second retreat provided a platform for updates on focused efforts across the institution and for receiving direction regarding national best practices for SGM care and research. We report the processes and outcomes of institution-wide retreats, which served as a platform for identifying gaps in organizational healthcare practices and research for SGM individuals with cancer. The strategies described herein may be readily scaled at other cancer hospitals seeking to learn and enact system-wide practice changes that support the needs of SGM patients and families.

Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States.

Cancer prevalence data for Black Americans is monolithic and fails to consider the diverse cultures and backgrounds within that community. For instance, African immigrants constitute a meaningful proportion of the foreign-born Black immigrants in the United States (42%), but the prevalence of cancer in the African immigrant community itself is unknown. Therefore, without accurate cancer prevalence data, it is impossible to identify trends and other key factors that are needed to support the health of African immigrants and their children. Moreover, it is impossible to understand how the culture and language of subgroups influence their cancer-related health behavior. While research in this area is limited, the existing literature articulates the need for culturally responsive and culturally tailored cancer education for African immigrants and their adolescent children, which is what we advocate for in this viewpoint paper. Existing projects demonstrate the feasibility of culturally responsive programming for adults; however, few projects include or focus on adolescents or children born to African immigrants. To best meet the needs of this understudied community, researchers must use culturally competent interventions alongside familiar, usable media. For adolescents, technology is ubiquitous thus, the creation of a culturally tailored digital intervention has immense potential to improve cancer awareness and prevention for youth and their community. More research is needed to address many of the existing research gaps and develop a rich understanding of the unique experience of cancer among African immigrant families that can be used to inform intervention development. Through this viewpoint, we review the current state of cancer-related research among African immigrant families in the United States. In this paper, we acknowledge the current knowledge gaps and issues surrounding measurement and then discuss the factors relevant to designing an educational intervention targeted at African immigrants and the role of African immigrant youth.

Efficacy and safety of caspofungin for the treatment of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.

We assessed the efficacy of a 3-week primary or salvage caspofungin regimen in patients with chronic obstructive pulmonary disease (COPD) and concomitant proven or suspected invasive pulmonary aspergillosis (IPA). Forty-four patients were treated with an initial loading caspofungin dose of 70 mg, followed by a daily dose of 50 mg for 20 days. The main efficacy endpoint was clinical effectiveness. Secondary endpoints included the clinical efficacy of caspofungin after 1 week, therapeutic efficacy based on the European Organization for Research and Treatment of Cancer and Mycoses Study Group Education and Research Consortium (EORTC/MSG) criteria, the sensitivity of different Aspergillus strains to caspofungin in vitro, and the safety of caspofungin. An assessment of 42 patients in the intention-to-treat group revealed efficacy rates of 33.33% within 1 week and 38.10% within 3 weeks. According to the EORTC/MSG criteria, the treatment success rate was 38.10%. The success rate of first-line treatment was 54.76%, whereas salvage treatment had a success rate of 45.24%. No adverse events were reported among the participants. Caspofungin is effective and safe as an initial or salvage treatment for patients with IPA and COPD.

Social network analysis of the CaRE2 health equity center: Team science in full display.

Cancer health disparities that exist in the Black or African American and Hispanic or Latino/x communities are scientific challenges, yet there are limited team science approaches to mitigate these challenges. This article's purpose is to evaluate the team science collaborations of the National Institutes of Health-funded Florida-California Cancer Research, Education & Engagement (CaRE2 ) Center partnership underscoring the inclusion of multidisciplinary team members and future under-represented minority (URM) cancer researchers. To understand our collaborative efforts, we conducted a social network analysis (SNA) of the CaRE2 Center partnership among University of Florida, Florida A&M University, and University of Southern California with data collected via the dimensions.ai application programming interface. We downloaded metadata for all publications associated with dimensions.ai IDs. The CaRE2 collaboration network increased over time as evidenced by accruing more external collaborators and more publishing of collaborative works. Degree centrality of key personnel was stable in each wave of the networks. CaRE2 key personnel averaged a total of 60.8 collaborators in 2018-2019 (SD = 57.4, minimum = 3, maximum = 221), and 65.8 collaborators in 2020-2021 (SD = 56.06, minimum = 4, maximum = 222). Betweenness was largely stable across all groups and waves. We observed a steady decline in transitivity, the probability that a pair of CaRE2 co-authors shared a third co-author, from 0.74 in 2018 to 0.47 in 2022. The SNA findings suggest that the CaRE2 Center partnership's publications show growth in team science collaborations with the inclusion of multidisciplinary team members from the three partner institutions and future URM cancer researchers who were mentored as trainees and early-stage investigators.

Exploring Gender Disparities in Factors Influencing Colorectal Cancer Screening Compliance in Singapore.

The uptake of colorectal cancer (CRC) screening remains suboptimal in Singapore. Existing research highlights gender-related disparities in screening behaviors. This study aims to evaluate the gender differences in factors associated with CRC screening compliance in Singapore, with a specific focus on cancer screening beliefs and knowledge on CRC screening guidelines. Data were collected from an online survey on cancer screening belief, knowledge, and practices in Singapore. Multivariate logistic regression analysis was conducted to identify independent factors associated with compliance in CRC screening. The study included 633 participants aged 50-69 years, eligible for CRC screening. Only 132 participants (20.9%) complied with CRC screening guidelines with no significant gender differences observed in compliance rates. Most participants held positive beliefs on routine screening (86.9%) and perceived screening benefits in improving treatment outcomes (89.6%) and reducing mortality rates (77.6%). However, both genders exhibited limited knowledge regarding CRC screening guidelines. Only 28.3% were aware that CRC screening should commence at age 50 years. While nearly half of participants knew FIT (44.7%) and colonoscopy (52.0%) as CRC screening modalities, only 27.5% and 15.2% recognized the recommended intervals for FIT and colonoscopy screening respectively. Multivariate analysis revealed a positive association between knowledge on CRC screening guidelines and CRC screening compliance for both genders. Gender-specific variations were observed in the factors associated with CRC screening compliance. Specifically, women with a family history of cancer, believing in routine cancer screening, and prior adherence to breast cancer screening and men within the older cohort (55-69 years) were more likely to comply with CRC screening. Low compliance with CRC screening was observed in Singapore. Targeted interventions should address gender-specific factors and highlight CRC screening guidelines as a crucial component of cancer education for entire screening eligible population in order to improve CRC screening compliance.

An Exploration of the Pillars of Leadership in Cancer Education.

Leadership plays a key role in cancer education (CE) and the success of its practices. Leaders in CE must effectively use their leadership skills to be able to communicate, collaborate, and educate their team members. There is a lack of formalized and standardized curriculums for institutions in developing leadership programs, including what themes to focus on in CE. In this article, the authors describe key pillars of leadership in CE that have presented themselves throughout their experience and within the literature. A search was conducted using the Ovid MEDLINE® database and articles were reviewed for eligibility. In this review, thirty articles were selected for their relevance to CE. With this literature search and the authors' reflections, four pillars of leadership in CE were identified: (1) leadership development, (2) collaboration, (3) diversity and equity, and (4) implementation. Within these themes, key areas of importance were discussed further, and barriers to CE leadership were identified. By reflecting upon pillars of leadership in CE, this article may be helpful for developing future leadership programs within CE. It is vital that initiatives continue to be held and barriers are addressed to increase leadership effectiveness within CE.

Risk Groups by the Needs for Help: Asian American Breast Cancer Survivors.

To supply proper and sufficient information and coaching through cancer education, it is important to decide who are risk groups among a target population. A decision tree analysis could help decide the characteristics of the risk groups. This study aimed to identify the combined characteristics of Asian American breast cancer survivors that were closely linked to high needs for help during their breast cancer survivorship process. The data on the needs for help among 185 Asian American breast cancer survivors from a parent clinical trial were included in this analysis. The instruments included the Supportive Care Needs Survey-Short Form 34 (SCNS-SF34) and multiple scales to measure the factors influencing the women's needs for help. The data were analyzed using latent profile analyses and decision tree analyses. The characteristics of the group with the highest needs for help were different depending on the types of needs. For instance, the group with the highest patient care/support needs for help score had high global symptom distress scores (cut point = 2.25) and high physical symptom distress (cut point = 1.57) and did not have regular access to health care (mean = 95.00; node 10). The findings suggest several risk groups to target in future interventions for cancer education to reduce the needs for help among this specific population. Multiple factors that could influence the needs for help among Asian American breast cancer survivors need to be considered in future intervention development for cancer education.

Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care.

Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods. This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment. A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person. Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment. The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care. Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.

The Chickahominy T.R.U.T.H. (Trust, Research, Understand, Teach, and Heal) Project-A Tribal Community-Academic Partnership for Understanding the Impact of Structural Factors on Perceived Cancer Risk in Rural Virginia.

In 2022, the Virginia Chickahominy Indian Tribe partnered with Virginia Commonwealth University Massey Comprehensive Cancer Center to investigate concerns about a potential cancer cluster near a local landfill. While investigating cancer clusters is complex due to long latency and multifactorial causes, the community's concerns about structural factors driving cancer risk warrant exploration. Thus, the Chickahominy T.R.U.T.H. (Trust, Research, Understand, Teach, and Heal) Project was created as a community-academic partnership to (1) identify structural factors and barriers associated with perceived cancer risk and care; (2) assess cancer knowledge, care access gaps, and perceived risks, including testing private and community water sources; (3) develop and deploy culturally tailored cancer education and resource navigation, including groundwater safety education, policies, and remediation. We will conduct 150 in-person interviews and water tests among residents within a four-mile radius of the landfill, and deploy 1000 structured questionnaires among Charles City County residents. In this paper, we provide an overview of the ongoing project design, development, and progress in support of the project's objectives. This collaborative investigation aims to address cancer health disparities, enhance research and health policy advocacy, and honor the sacred knowledge of an underserved community, laying the groundwork for a long-term partnership to guide future research questions.

Efficacy of Community Health Worker-Delivered Family Health History-Based Breast Cancer Education and Services Among Chinese Americans.

Family health history (FHH) is an evidence-based genomics tool used in cancer prevention and education. Chinese Americans, the largest Asian American group, face unique barriers in FHH collection and communication. This study aimed to evaluate the efficacy of culturally and linguistically appropriate community health worker (CHW)-delivered FHH-based breast cancer (BC) education and services to Chinese Americans. A total of 1129 Chinese Americans received FHH-based BC education and service delivered by our trained Chinese American CHWs. Participants responded to evaluation surveys before, immediately after, and 3months after the education and service. Participating Chinese Americans showed significant increases in rates of collecting FHH of BC, discussing FHH of BC with family members, informing their primary care physicians of their FHH of BC, and discussing their FHH of BC with their primary care physicians at 3months post-education and service compared to the baseline data (all Ps < 0.01). Attitudes, intention, and self-efficacy related to FHH of BC communication and collection and FHH of BC knowledge were improved both immediately after and 3months after the delivery of the education and services (all Ps < 0.01). Within 3months, ~ 14.3% of participants who had a high risk of BC based on FHH reported visiting geneticists for genetic evaluation. Our Chinese American CHW-delivered FHH-based BC education and services showed initial success in increasing knowledge, collection and communication of BC-related FHH, and genetic service utilization among Chinese American participants. This study can serve as a starting point for conducting more robust studies, such as randomized controlled trials, in the future.

Systematic Review of Interventions Addressing Racial and Ethnic Disparities in Cancer Care and Health Outcomes.

Cancer health disparities result from complex interactions among socioeconomic, behavioral, and biological factors, disproportionately affecting marginalized racial and ethnic groups. The objective of this review is to synthesize existing evidence on interventions addressing racial or ethnic disparities in cancer-related health care access and clinical outcomes. A comprehensive search of Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science Core Collection was conducted from database inception to February 23, 2023. Controlled vocabulary and keywords helped to identify studies on cancer-related disparities and interventions in adults age 18 years or older. Two reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Of 7,526 screened studies, 34 met the inclusion criteria involving 24,134 participants. Most studies focused on breast cancer (n = 17) and Hispanic/Latino populations (n = 10) and enrolled participants primarily from community-based sites (n = 19). Twenty-one studies examined patient-centered outcomes, such as health-related quality of life and psychological well-being, while 15 studies assessed process-of-care outcomes, such as timeliness of care. Most studies followed a community-based participatory research framework. Five patient-centered outcome studies reported a positive intervention effect, often combining cancer education with psychological well-being interventions. Among the 15 process-of-care outcome studies, nine reported positive effects, with the majority (n = 8) being navigation-based interventions. This systematic review emphasizes the vital role of community partnerships in addressing racial and ethnic disparities in oncology care and highlights the need for standardized approaches in intervention research because of the heterogeneity of studied interventions. Furthermore, the prevailing emphasis on breast cancer and Hispanic populations indicates the need for future investigations into other priority demographic groups.

Systematic review of Aboriginal and Torres Strait Islander peoples’ experiences and supportive care needs associated with cancer

BackgroundPersistent disparities exist between Aboriginal and Torres Strait Islander peoples (the Indigenous peoples of Australia) and non-Indigenous Australians associated with cancer, with Aboriginal and Torres Strait Islander peoples experiencing a longer time to treatment, higher morbidity rates, and higher mortality rates. This systematic review aimed to investigate findings and recommendations in the literature about the experiences and supportive care needs of Aboriginal and Torres Strait Islander peoples with cancer in Australia.MethodsA qualitative systematic review was conducted using thematic analysis. Database searches were conducted in CINAHL, Informit, MEDLINE, ProQuest, Scopus, and Web of Science for articles published between January 2000 and December 2021. There were 91 included studies which were appraised using the Mixed Methods Appraisal Tool. The included studies reported on the experiences of cancer and supportive care needs in Aboriginal and Torres Strait Islander populations.ResultsSix key themes were determined: Culture, family, and community; cancer outcomes; psychological distress; access to health care; cancer education and awareness; and lack of appropriate data. Culture was seen as a potential facilitator to achieving optimal cancer care, with included studies highlighting the need for culturally safe cancer services and the routine collection of Aboriginal and Torres Strait Islander status in healthcare settings.ConclusionFuture work should capitalize on these findings by encouraging the integration of culture in healthcare settings to increase treatment completion and provide a positive experience for Aboriginal and Torres Strait Islander peoples with cancer.

Ethnic and Gender Differences in Sun-Related Cognitions Among College Students: Implications for Intervention.

Skin cancer incidence and prognosis vary by ethnicity and gender, and previous studies demonstrate ethnic and gender differences in sun-related cognitions and behaviors that contribute to this disease. The current study sought to inform skin cancer interventions tailored to specific demographic groups of college students. The study applied the prototype willingness model (PWM) to examine how unique combinations of ethnic and gender identities influence sun-related cognitions. Using data from a survey of 262 college students, the study tested whether self-reported sun-related cognitions were different for White women, Hispanic women, White men, and Hispanic men. Path modeling was also used to identify which PWM cognitions (e.g., prototypes, norms) were the strongest predictors of risk and protection intentions and willingness in each demographic group. Several differences in sun-related cognitions and PWM pathways emerged across groups, emphasizing the need for tailored skin cancer education and interventions. Results suggest that, for White women, interventions should primarily focus on creating less favorable attitudes toward being tan. Interventions for Hispanic women may instead benefit from manipulating perceived similarity to sun-related prototypes, encouraging closer personal identification with images of women who protect their skin and encouraging less identification with images of women who tan. For White men, skin cancer interventions may focus on creating more favorable images of men who protect their skin from the sun. Lastly, interventions for Hispanic men should increase perceived vulnerability for skin cancer.

Medicaid expansion and palliative care for advanced-stage liver cancer

Medicaid expansion (ME) has contributed to transforming the United States healthcare system. However, its effect on palliative care of primary liver cancers remains unknown. This study aimed to evaluate the association between ME and the receipt of palliative treatment in advanced-stage liver cancer. Patients diagnosed with stage IV hepatocellular carcinoma or intrahepatic cholangiocarcinoma were identified from the National Cancer Database and divided into pre-expansion (2010-2013) and postexpansion (2015-2019) cohorts. Logistic regression identified predictors of palliative treatment. Difference-in-difference (DID) analysis assessed changes in palliative care use between patients living in ME states and patients living in non-ME states. Among 12,516 patients, 4582 (36.6%) were diagnosed before expansion, and 7934 (63.6%) were diagnosed after expansion. Overall, rates of palliative treatment increased after ME (18.1% [pre-expansion] vs 22.3% [postexpansion]; P<.001) and are more pronounced among ME states. Before expansion, only cancer type and education attainment were associated with the receipt of palliative treatment. Conversely, after expansion, race, insurance, location, cancer type, and ME status (odds ratio [OR], 1.23; 95% CI, 1.06-1.44; P=.018) were all associated with palliative care. Interestingly, the odds were higher if treatment involved receipt of pain management (OR, 2.05; 95% CI, 1.23-2.43; P=.006). Adjusted DID analysis confirmed increased rates of palliative treatment among patients living in ME states relative to non-ME states (DID, 4.4%; 95% CI, 1.2-7.7; P=.008); however, racial disparities persist (White, 5.6; 95% CI, 1.4-9.8; P=.009; minority, 2.6; 95% CI, -2.5 to 7.6; P=.333). The implementation of ME contributed to increased rates of palliative treatment for patients residing in ME states after expansion. However, racial disparities persist even after ME, resulting in inequitable access to palliative care.

Developing “The Health After Cancer Podcast” to amplify cancer survivors’ voices through digital storytelling

BackgroundCancer survivors experience complex medical and psychosocial challenges after a cancer diagnosis, leading to unmet informational and emotional needs. There is a paucity of cancer survivorship educational resources co-created by survivors and medical professionals. ObjectiveOur aim was to create an educational resource for cancer survivors, caregivers, and medical professionals that would leverage digital storytelling to address survivorship topics. Patient involvementOur content and production team included cancer survivors, clinicians, educators, and design experts. All content was co-created by cancer survivors and medical experts. MethodsWe conducted an environmental scan of existing cancer survivorship educational resources in academic and public domains. Applying human-centered design principles, we incorporated patient perspectives through advisory board meetings and focus groups and identified a podcast as the preferred medium. We selected content and speakers, produced the podcast, and developed a corresponding website. ResultsBased on patient recommendations, podcast episodes address mental health, fear of cancer recurrence, relationships, parenting, relating to a new body, care transitions for adult survivors of childhood cancer, disclosing health information, and financial burden of cancer. Podcast guests were invited based on lived or learned experience in these domains. Thirteen guests (survivors, experts) and four hosts (two cancer survivors, two oncologists) co-created 15 podcast episodes. Podcast guests found the storytelling experience to be powerful and therapeutic. DiscussionDigital storytelling is a scalable and accessible educational tool for communicating complex survivorship concepts that can amplify survivors’ voices and increase awareness among survivors and clinicians. Co-creation of educational resources for cancer survivorship by survivors and professionals is a feasible and innovative educational strategy. Practical ValueA podcast created by and for cancer survivors in partnership with medical experts highlights opportunities for peer-to-peer digital storytelling to foster community among survivors and caregivers. FundingPodcast production was supported by the Stanford Comprehensive Cancer Center.

Impact of Virtual Navigation on the Education and Access of Patients with Cancer: A National Mixed Methods Investigation.

Despite growing evidence of efficacy, oncology patient navigation is not ubiquitously offered. Navigation may reduce barriers to cancer care, yet geographic location may limit patient access. To overcome geographical barriers and increase patient education in oncology, our medical center developed a virtual navigation program. To examine the efficacy of the Virtual Navigation Program designed to increase patient access and education across local and national contexts. In this mixed-methods study, a total of 105 individuals completed an online survey administered nationally to oncology patients who used the navigation program. Clinical and demographic data were collected. Nonparametric tests were used for group comparisons (Wilcoxon Signed-Ranks test). Virtual navigation increased access as the majority of patients utilized the Virtual Navigation Program beyond the local area; 42% of patients were local; 58% were patients located across the US. 55 (52%) were female; 25% were non-White. Pancreatic cancer was the largest tumor type: 51 (49%). Patients agreed the virtual cancer education helped them make critical health choices (mean 4.89 SD = 84); understand their diagnosis (mean 4.44 SD = .77); were able to make informed decisions (mean 4.43 SD = .83), and empowered to manage their cancer care (mean 4.58 SD = .82). Post navigation, the user experience survey revealed significant increases in a subset of patients' cancer knowledge (P < 0.001), access to quality cancer education (P = 0.045), decision-making in cancer care (P < 0.05), and coordinated cancer care (P = 0.03). This study explores a unique role that virtual navigation may play in helping accommodate healthcare for many cancer patients in underserved areas. The use of innovative aspects of research and education in virtual navigation may be successful in promoting patient empowerment in the cancer continuum. Internet-strategies are needed to inform sustainable patient navigation in low-resource contexts.

Summer Cancer Research Experience for High School Students from Historically Marginalized Populations in Kansas City.

The Accelerate Cancer Education (ACE) summer research program at The University of Kansas Cancer Center (KUCC) is a six-week, cancer-focused, summer research experience for high school students from historically marginalized populations in the Kansas City metropolitan area. Cancer affects all populations and continues to be the second leading cause of death in the United States, and a large number of disparities impact racial and ethnic minorities, including increased cancer incidence and mortality. Critically, strategies to bolster diversity, equity, inclusion, and accessibility are needed to address persistent cancer disparities. The ACE program offers an educational opportunity for a population of students who otherwise would not have easy access onto a medical center campus to make connections with cancer physicians and researchers and provides a vital response to the need for a more diverse and expansive oncology workforce. Students grow their technical, social, and professional skills and develop self-efficacy and long-lasting connections that help them matriculate and persist through post-secondary education. Developed in 2018, the ACE program has trained 37 high school junior and senior students. This article describes the need for and how we successfully developed and implemented the ACE program.