Reduce Cancer Disparities Research Articles

Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities.

The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers serving Alaska Native people in rural/remote communities. A total of 28 provider (physicians, advanced practice, and Community Health Aides/Practitioners) interviews were held from 1 February to 30 November 2021. Colonoscopy provider-level barrier themes included time, competing priorities, and staffing, while system-level barriers included travel costs, weather, and the COVID-19 pandemic. Multi-target stool DNA (mt-sDNA) barrier themes included test viability and unfamiliarity, and previous stool tests experiences. For both tests, limited medical record reminders was a major barrier. Facilitator themes for both tests included community outreach, cultural competency and patient navigation, and clinic/system improvements. In-depth interviews with tribal health providers showed that adding mt-sDNA testing may help address system-level colonoscopy barriers such as waitlists and travel costs, but other barriers remain. Further research is needed into patient barriers and facilitators, as well as the effectiveness of integrating mt-sDNA into a geographically dispersed tribal health system to reduce cancer disparities and build equity in CRC prevention among Alaska Native people.

Community Outreach and Engagement at U.S. Cancer Centers: Notes from the Third Cancer Center Community Impact Forum.

Community outreach and engagement (COE) is a fundamental activity of cancer centers as they aim to reduce cancer disparities in their geographic catchment areas. As part of COE, NCI-Designated Cancer Centers must monitor the burden of cancer in their catchment area, implement and evaluate evidence-based strategies, stimulate catchment area relevant research, support clinical trial enrollment, and participate in policy and advocacy initiatives, in addition to other responsibilities. The Cancer Center Community Impact Forum (CCCIF) is a national annual meeting of COE professionals who work at or with cancer centers across the country. CCCIF grew out of earlier discussions at American Society of Preventive Oncology (ASPO) annual meetings, where COE was often discussed, but not exclusively. The third annual CCCIF meeting-hosted by the Sidney Kimmel Cancer Center at Thomas Jefferson University-was held in June 2022 in Philadelphia, PA, where more than 200 participants listened to dynamic presentations across 12 COE-related panel sessions. CCCIF leadership and ASPO AD/PL Workshop Planners worked together on the agenda. The 12 sessions used a COE lens to focus on: Diversity, Equity, and Inclusion; Policy; State Cancer Coalitions; Evaluation and Metrics; Implementation Science; In-reach; Outreach; Training and Education; Funding, Personnel and Resources; Clinical Trials; Innovative Methods; and Lessons from the COVID-19 pandemic. This article is a summary of main points and key lessons from each session, as well as a summary of overarching themes that were evident across the sessions.

Addressing Cancer Disparities Through Community Engagement: Lessons and Best Practices.

Cancer disparities continue to be a significant public health challenge, disproportionately affecting certain communities in terms of incidence, mortality, and access to quality care. Addressing these disparities requires a multifaceted approach that involves not only healthcare professionals and researchers but also the active participation and collaboration of the affected communities themselves. Community engagement has emerged as a promising strategy to reduce cancer disparities and promote health equity. This review article synthesizes the existing literature and examines the role of community engagement in addressing cancer disparities. It explores various approaches and best practices utilized in community engagement initiatives to empower and involve diverse populations in the fight against cancer. The review discusses key lessons learned from successful programs and identifies challenges faced in implementing such initiatives. The article highlights the importance of cultural competence, trust-building, and meaningful collaboration between stakeholders, including community leaders, healthcare providers, researchers, and policymakers. It emphasizes the significance of tailoring interventions to specific community needs, acknowledging cultural differences, and fostering a two-way exchange of knowledge and resources. Moreover, this review investigates the impact of community engagement on cancer prevention, early detection, treatment adherence, and survivorship outcomes. It sheds light on the role of community-based participatory research and other innovative strategies in generating evidence and facilitating the translation of research findings into real-world interventions. In conclusion, this review underlines the potential of community engagement in addressing cancer disparities and promoting health equity. By involving communities as active partners in cancer control efforts, healthcare systems can design more effective and sustainable interventions. This approach not only contributes to reducing cancer disparities but also fosters a sense of ownership and empowerment within the communities affected, paving the way for a more equitable and inclusive healthcare landscape.

The impact of minority health social vulnerability on population-based cancer incidence.

e22501 Background: Area-level social determinants of health impact cancer outcomes. However, less is known about how the Minority Health Social Vulnerability Index (MHSVI) affects cancer incidents at the county level. Methods: County-level data from the Agency for Health Care Research and Quality from 2019 for 3,232 counties were analyzed. MHSVI themes: socioeconomic, household composition, minority status/language, housing/transportation, healthcare infrastructure/access, and medical vulnerability were the exposures (continuous). Overall MHSVI were categorized into low (.01/.25), moderate (.26/.74), and high (.75/1) percentiles. The outcome was the total number of cancer incidents (continuous). Covariates include rural-urban regions. Using STATA/MPv.17, unadjusted and adjusted negative binomial regressions with population weighting were performed. P-values of ≤0.05 were considered statistically significant. Results: There were 201,547 total cancer incidents. Adjusted analyses reveal that cancer increased as vulnerability increased especially for household composition (IRR. 1.19, 95% CI: 1.15 – 1.23), healthcare infrastructure/access (IRR. 0.89, 95% CI: 0.87 – 0.91), and housing/transportation (IRR. 0.88, 95% CI: 0.85 – 0.90) themes. Cancer increased in moderate MHSVI areas (IRR. 0.94, 95% CI: 0.92 – 0.96) and high (IRR. 0.86, 95% CI: 0.84 – 0.88) areas compared to low. Conclusions: This study discovered social disparities in cancer incidence. Quantifying the influence of MHSVI on cancer incidents could provide insight into the design/focus of future initiatives aimed at reducing cancer disparities. [Table: see text]

Cancer equity for those impacted by mass incarceration.

The cancer disparities between people with incarceration histories compared with those who do not have those histories are vast. Opportunities for bolstering cancer equity among those impacted by mass incarceration exist in criminal legal system policy; carceral, community, and public health linkages; better cancer prevention, screening, and treatment services in carceral settings; expansion of health insurance; education of professionals; and use of carceral sites for health promotion and transition to community care. Clinicians, researchers, persons with a history of incarceration, carceral administrators, policy makers, and community advocates could play a cancer equity role in each of these areas. Raising awareness and setting a cancer equity plan of action are critical to reducing cancer disparities among those affected by mass incarceration.

Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study.

Understanding Black women's Papanicolaou (Pap) screening experiences can inform efforts to reduce cancer disparities. This study examined experiences among both US-born US Black women and Sub-Saharan African immigrant women. Using a convergent parallel mixed methods design, Black women born in the USA and in Sub-Saharan Africa age 21-65 years were recruited to participate in focus groups and complete a 25-item survey about patient-centered communication and perceived racial discrimination. Qualitative and quantitative data were integrated to provide a fuller understanding of results. Of the 37 participants, 14 were US-born and 23 were Sub-Saharan African-born Black women. The mean age was 40.0 ± 11.0, and 83.8% had received at least one Pap test. Five themes regarding factors that impact screening uptake emerged from the focus groups: (1) positive and negative experiences with providers; (2) provider communication and interaction; (3) individual barriers to screening uptake, (4) implicit bias, discrimination, and stereotypical views among providers, and (5)language barrier. Survey and focus group findings diverged on several points. While focus group themes captured both positive and negative experiences with provider communication, survey results indicated that most of both US-born and Sub-Saharan African-born women experienced positive patient-centered communication with health care providers. Additionally, during focus group sessions many participants described experiences of discrimination in health care settings, but less than a third reported this in the survey. Black women's health care experiences affect Pap screening uptake. Poor communication and perceived discrimination during health care encounters highlight areas for needed service improvement to reduce cervical cancer disparities.

Disparities in incidence and trends of colorectal, lung, female breast, and cervical cancers among non-Hispanic American Indian and Alaska Native people, 1999-2018.

This study is the first to comprehensively describe incidence rates and trends of screening-amenable cancers (colorectal, lung, female breast, and cervical) among non-Hispanic AI/AN (NH-AI/AN) people. Using the United States Cancer Statistics AI/AN Incidence Analytic Database, we, calculated incidence rates for colorectal, lung, female breast, and cervical cancers for NH-AI/AN and non-Hispanic White (NHW) people for the years 2014-2018 combined. We calculated age-adjusted incidence rates (per 100,000), total percent change in incidence rates between 1999 and 2018, and trends over this time-period using Joinpoint analysis. Screening prevalence by region was calculated using Behavioral Risk Factor Surveillance System data. Rates of screening-amenable cancers among NH-AI/AN people varied by geographic region and age at diagnosis. Over half of all lung and colorectal cancers in NH-AI/AN people were diagnosed at later stages. Rates of lung and colorectal cancers decreased significantly between 1999-2018 among NH-AI/AN men, but no significant changes were observed in rates of screening-amenable cancers among NH-AI/AN women. This study highlights disparities in screening-amenable cancers between NH-AI/AN and NHW people. Culturally informed, community-based interventions that increase access to preventive health services could reduce cancer disparities among AI/AN people.

Cancer Screening Rates and Outcomes for Justice-Involved Individuals: A Scoping Review.

Individuals who have been incarcerated or under community supervision have elevated cancer mortality. This review summarizes existing knowledge on implementation and outcomes of cancer screening for justice-involved individuals to identify opportunities for reducing cancer disparities. This scoping review identified 16 studies published between January 1990 and June 2021 that reported cancer screening rates and outcomes in U.S. jails or prisons or for individuals under community supervision. Most studies evaluated cervical cancer screening, while fewer studies evaluated screening for breast, colon, prostate, lung, and hepatocellular cancers. Although incarcerated women are often up to date with cervical cancer screening, only about half had recent mammograms and only 20% of male patients were up to date with colorectal cancer screening. Justice-involved patients are at high risk of cancer, yet few studies have evaluated cancer screening for these populations and screening rates for many cancers appear low. The findings suggest that intensification of cancer screening for justice-involved populations may address cancer disparities.

Abstract PL03-05: Early Engagement Equals Early Detection

Abstract PL03-05: Early Engagement Equals Early Detection

Abstract 1919: Cancer Wellness Hubs: A pop-up information model to reduce cancer disparities in medically-underserved, minority communities

Abstract Background: To make cancer information accessible to the diverse communities of LA inan equitable manner, cancer information must be provided in culturally and language specific ways. This allows for making informed, accurate, and timely decisions about cancer whether it is preventive,treatment, or survivorship. The Lazarex Cancer Foundation has teamed up with the USC to establish Lazarex Cancer Wellness Hubs, using a “pop- up” model conceptto bring vital cancer information about cancer prevention, screening, diagnosis, clinical trials and cancersupport services directly into the neighborhoods of those most impacted by cancer. Methods: We teamed up with community-based organizations, including the Weingart East LA YMCA and other YMCA’s inKoreatown and South Central LA, the KJLH radio station, ata women’s conference in Long Beach, and the Taste of Soul in the Crenshaw district,and othercommunity based organizations, schools and venues to bring cancer information to the community inculturally and linguistically sensitive ways. The Taste of Soul event is the largest street festival in LA and attracts over 350,000+. A speaker series developed provides education, guidance, consultation, comfort, and support to enhance communitymembers’ trust and reduce their fear regarding cancer, cancer screening, treatment, clinical trials, andsurvivor skills. We established a Cafecito (coffee) with the experts, a monthly series where cancer patients,caregivers, and/or family members with questions in the community can join to have cancer relatedquestions answered. Results: We provided cancer information to 3,300 individuals between July 2021/October 2022. Majority were females(83%), including family members of cancer survivors or the worried well, who are concerned about cancerin their families, patients, and community at large. Over 600 attended our speaker series, and 2,030 received information via our pop-up hubs. We supported over 150 individuals in support groups & supported culturally specific community events, support groups and activities reaching 256 individuals. We have helped address food insecurity & access to healthcare issues. The estimated listening audience of KJLHis 275,000 on any given day of the week. Conclusion: The diverse communities of LA are better informed about cancer,cancer risk-reduction life-style behavior changes, cancer screening, treatment, clinical trials, and survivorskills. Much education has been provided for individuals to learn and be informed about cancer in ourvulnerable diverse communities. The Lazarex Cancer Foundation Cancer Wellness Hubs proved to be aneffective strategy to reach communities directly in their own “backyard”. The intent is to replicate this effortin other diverse cities throughout the nation becoming a model in our ongoing effort to reduce cancerdisparities. Citation Format: Lourdes A. Baezconde_Garbanati, Elena Nieves, Rosa Barahona, Marya Shegog, Dana Dornsife, Stephanie Rivera. Cancer Wellness Hubs: A pop-up information model to reduce cancer disparities in medically-underserved, minority communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1919.

Abstract IA018: “Pursuing Wicozani for the Oceti Sakowin”: Reducing cancer disparities among AI/AN in the Great Plains

Abstract American Indian and Alaska Native (AI/AN) populations are among the underserved minority groups in the country and have the lowest survival rates for nearly all types of cancer of any subpopulation in the United States. Great Plains AI/AN populations have the highest age-adjusted cancers mortality compared to Native Americans from any other region. Addressing disparities in cancer outcomes among Great Plains AI/AN populations poses challenges in transportation, access to services, linguistic, and cultural variates. The Great Plains Tribal Leaders Health Board Community Health Department offers a variety of programs and projects to address these challenges and reduce these cancer disparities. Citation Format: Richard J. Mousseau. “Pursuing Wicozani for the Oceti Sakowin”: Reducing cancer disparities among AI/AN in the Great Plains [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA018.

Abstract B053: Cancer Wellness Hubs: Bringing cancer information directly to underserved communities

Abstract Background: Cancer information is greatly needed for patients to make accurate and timely decisions about their care. However, this is often not available in culturally and language specific ways, and not easily accessible to minority populations. The Lazarex Cancer Foundation has teamed up with the USC Norris Comprehensive Cancer center to establish Cancer Wellness Pop up hubs in the Southern California diverse community to bring cancer information directly into people’s neighborhoods. Methods: During the period of October 2021 through May 2022 we teamed up with local community-based organizations, including the Los Angeles Weingart YMCA in Boyle Heights and other YMCA’s in Koreatown and South Central Los Angeles, the KJLH radio station (102.3 FM, 1050 AMM, 106.5 FM), at a women’s conference in Long Beach, as well as with other community based organizations and venues to bring cancer information to the community in language and culturally appropriate ways. Further we developed a speakers’ series on line which has brought together cancer experts responding to most frequently asked questions on cancer to manage a variety of topics, and to speak about clinical trials participation. We also established a Cafecito (coffee) with the experts, a weekly series where cancer patients and family members with questions in the community could join to have cancer related questions answered, and established a series of wellness workshops. Results: We provided cancer information to 1359 individuals between October 2021-May 2022. Of these, the majority were females, including family members of cancer survivors or the worried well, who are concerned about cancer in their families, patients, and the community at large. Almost 500 have attended our speakers’ series, and 471 have received information via our Pop-up hubs. We have supported over 100 individuals in support groups and supported culturally specific community events such as Celebrate Life Car Parade, and the Men’s Cancer Network support groups and activities reaching 261 individuals. The estimated listenership of KJLH is 275,000 on any given day of the week. Conclusion: The Lazarex Foundation Cancer Wellness Hubs are a proven strategy to reach communities directly in their own neighborhoods. Much information has been provided to plant the seed for individuals to learn about and become informed about cancer in their communities. Prevention information has been critical for keeping populations at risk healthy and improving dialogue about participation in research and clinical trials among diverse vulnerable communities. The Cancer Wellness Hubs are being implemented in other cities around the U.S. and have become a model for the nation to reduce cancer disparities one community at a time. Citation Format: Lourdes A. Baezcondee-Garbanati, Elena Nieves, Erykah Walton, Rosa Barahona, Marya Shegog. Cancer Wellness Hubs: Bringing cancer information directly to underserved communities [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B053.

Abstract C086: A summary of findings from the Breast Cancer, Race and Place (BCRP) study on structural racism and breast cancer survival disparities in the United States, based in Milwaukee, WI

Abstract Racial disparities in breast cancer survival are significant, with only 68% of US Black women diagnosed with breast cancer remaining alive 10 years post-diagnosis, compared to 84% of White women. However, the size of racial disparities in breast cancer mortality varies geographically across the US. Such geographical variation suggests that disparities are not inevitable, and this variation has not been explained. Structural racism and racial residential segregation are widely considered to contribute to health disparities and may partially explain geographical variation in the size of the disparities. While some studies have shown that segregation is related to poor survival, others have found that this is not always the case, and some studies highlight the case of ethnic enclaves, which may be protective. The NCI funded Breast Cancer, Race and Place (BCRP) study is a national study of structural racism and breast cancer survival with three aims: (1) Construct new metrics of structural racism at the local level for the largest US metropolitan areas, (2) Determine whether these measures are related to breast cancer survival disparities among Black, Hispanic and Non-Hispanic White women, and whether relationships are mediated by local stressors, social resources, or opportunities, and (3) Explore the ways in which Black and Hispanic breast cancer survivors in a highly segregated metropolitan area (Milwaukee, WI) navigate cancer survivorship in the context of segregation. The project is supported by an interdisciplinary research team and a community advisory board. We have published several studies based on this work with others in review or in preparation and share an overview of this body of work here. This summary of findings includes: (1) a description of new measures of contemporary racial bias and property location based bias (redlining) in mortgage lending, (2) a direct association between redlining and breast cancer survival in older women diagnosed with breast cancer in the US, (3) collaborative work using these metrics in other cohorts and locations, (4) a clear gradient association between historic redlining and contemporary redlining, (5) new evidence of potential mediating factors, (6) qualitative evidence of lived experience of Black and Hispanic survivors in Milwaukee, WI, and (7) a new web-based tool to explore and download mortgage lending bias metrics. We hope that this work will support the development of multi-sectoral interventions to reduce cancer disparities by targeting local systems and policies, including in the housing sector. Citation Format: Kirsten M. M. Beyer, BCRP Team. A summary of findings from the Breast Cancer, Race and Place (BCRP) study on structural racism and breast cancer survival disparities in the United States, based in Milwaukee, WI [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C086.

Learning Through Doing: Comprehensive Programming for a Training Program in Cancer Disparities

In the United States, preparing researchers and practitioners for careers in cancer requires multiple components for success. In this reflection article, we discuss our approach to designing a comprehensive research training program in cancer disparities. We focused on elements that provide students and early career scientists a deep understanding of disparities through first-hand experiences and skills training necessary to build a research career in the area. Our Educational Program sits within the framework of an NCI P20 program, “UHAND (University of Houston/MD Anderson Cancer Center)”, jointly established by an NCI-designated comprehensive cancer center and a minority-serving university as a collaborative partnership devoted to the elimination of cancer inequities among disproportionately affected racial and ethnic groups (UHAND Program to Reduce Cancer Disparities; NCI P20CA221696/ P20CA221697). The Education Program was designed to build on and enhance skills that are critical to pursuing a career in cancer disparities research at the undergraduate, doctoral, and post-doctoral levels—such as scientific communication, career planning and development, professional and community-based collaboration, and resilience in addition to solid scientific training. As such, our program integrates (1) opportunities for learning through service to community organizations providing resources to populations with documented cancer disparities, (2) a tailored curriculum of learning activities with program leadership and mentored research with scientists focused on cancer disparities and cancer prevention, (3) professional development training critical to career success in disparities research, and (4) support to address unique challenges faced by trainees from backgrounds that are historically underrepresented in research.

Development of a Community Advisory Board to Guide Research About Cancer Disparities in the Black and African American Community.

Researchers who aim to serve a community (i.e., racial, gender, ethnic group) of which they are not a part must do foundational work to understand that community and build intentional, thoughtful collaborations with the community to guide their work. This article aims to share a case exemplar of the formation period of a community advisory board (CAB) that conducts research focused on improving health equity in the Black and African American community. CAB development has three phases: formation, operation, and maintenance. Previous work has described and provided best practices for each phase. This article focused on the first phase, formation. Guided by critical race theory, with guidance from her mentor, a researcher partnered with a research assistant and a community health educator to develop a CAB. Details of their processes-which apply to the formation of other CABs-are presented. During the board formation period, the major focus has been relationship building and developing a shared mission: "To work in partnership with researchers at the University of North Carolina to reduce cancer disparities in Black/African American communities by informing research and program development. As a liaison between the community and researchers, the Community Advisory Board will identify community needs, promote evidence-based interventions and information, raise awareness about health disparities in communities, and educate researchers." CAB formation is nuanced and unique, dependent upon the nature of the research to be conducted and the characteristics of the community and researchers. This case exemplar provides valuable insights to other researchers working to build community partnerships.

Impact of structural racism on inclusion and diversity in precision oncology: A scoping and critical review of the literature.

Inclusion and diversity in precision oncology are essential in reducing cancer disparities among racial and ethnic groups. However, present studies have favored the recruitment and participation of Whites, with limited applicability of their results to minority groups. Many reasons for their underrepresentation are downstream manifestations of structural racism. Therefore, this scoping review provides a precise mapping of recruitment and participation barriers for minorities in precision oncology that are associated with structural racism, including a critical appraisal of how disciplinary norms, paradigms, and tools used therein could inadvertently contribute to unforeseen inclusion and diversity challenges. Empirical and theoretical publications from Web of Science and PubMed were searched and analyzed to identify recruitment and participation barriers for minorities in precision oncology. In addition, using the public health critical race praxis (PHCRP) as guiding analytical framework, empirical studies were analyzed to identify unforeseen barriers resulting from simplification processes, assumptions, norms, paradigms, and tools used during the research process. One-hundred thirty-five barriers to recruitment and participation were identified or reported in included publications. They were subsequently categorized as being a manifestation of one of the following forms of racism, namely internalized, interpersonal, institutional, and structural racism. The PCHRP analysis revealed four additional factors to be considered in precision oncology studies in ensuring appropriate representation of their study populations. Future interventions aimed at reducing health disparities should focus predominantly on barriers associated with structural and institutional racism, which should then have ripple effects on other forms of racism. Importantly, the four factors identified through the PHCRP framework could further explain the lower participation rates of minorities in precision oncology and related activities. Therefore, they should be given due consideration by all stakeholders involved in the precision oncology ecosystem, from researchers and healthcare professionals to policy-makers, research ethics committees, and funders.

Improving Cancer Care in the HIV Population: Qualitative Research to Identify Provider Knowledge, Attitudes and Practices

<h3>Purpose/Objective(s)</h3> Cancer patients living with HIV are less likely to receive cancer treatment and have worse cancer survival than HIV-uninfected patients. There is minimal published data exploring drivers of the disparity and even less on mitigation strategies. We aimed to explore clinician cancer treatment decision-making for patients living with HIV, focusing on oncologist knowledge, attitudes, and practices. <h3>Materials/Methods</h3> We conducted semi-structured in-depth interviews with 25 medical, radiation, and surgical oncologists from two academic medical centers and several community practices. Participants were eligible if they recently had a consultation with a patient with both HIV and cancer as assessed through medical record review at the academic centers and by self-report for community practices. The interview guide explored oncologist attitudes, stigma, knowledge, and practices during the cancer treatment decision-making process. We audio recorded and transcribed interviews and analyzed data using an open, iterative analysis approach with ATLAS.ti. <h3>Results</h3> Study participants were 32% medical oncology, 40% radiation oncology, and 28% surgical oncology. Most (64%) were within 15 years of terminal training and between 30 and 49 years of age (84%). Many (n=14) participants described knowledge gaps on HIV-specific education during medical school and subsequent oncology training as an impediment to providing optimal care to people with HIV. Oncologists noted that patients often had financial, logistic, and psychosocial challenges that were not adequately addressed in the clinical setting. Although oncologists themselves felt comfortable discussing HIV, some (n=8) reported concerns regarding inadvertent HIV disclosure resulting in stigma from patient companions or caregivers unaware of the HIV diagnosis. Less than half of oncologists (n=11) reported collaborating with the patient's HIV care team before and during cancer therapy. <h3>Conclusion</h3> This qualitative study of oncologists in the US demonstrates that oncologists face challenges when caring for people with HIV. Point of care tools, particularly those geared towards enhancing oncologist education and connection with other care teams such as HIV/infectious diseases and social work, may enhance cancer care and reduce cancer disparities for people living with HIV.

Impact of a Cancer Health Education Curriculum Among Milwaukee Public High School Students.

In Milwaukee and nationwide, cancer incidence, late-stage diagnosis, and mortality are notably higher among some racial/ethnic populations. Cancer education has the potential to impact cancer burden and reduce cancer disparities. In particular, the addition of a service-learning component to academic curriculums has been shown to improve student learning as well as positively impact the surrounding community. This study implemented a cancer health education curriculum (CHEC) at a Milwaukee public high school with the goal of addressing cancer knowledge, fear and fatalism beliefs, and risk behaviors. The curriculum included interactive learning sessions and a service-learning final project. Five-hundred twenty-one students also completed pre- and post-surveys assessing cancer knowledge, fear and fatalism, risk behaviors, cancer-related communication, and a qualitative question asking what they hoped to gain (pre) or did gain (post) from the course. Results indicate (1) a significant improvement in cancer knowledge (p < 0.0001), (2) a decrease in cancer fear and fatalism (p < 0.0001), (3) an increase in fruit consumption (p < 0.0001), (4) a decrease in screen time (p = 0.0004), and (5) an increase in how often students spoke with their family about cancer (p < 0.0001). Qualitative data reflect important gains such as increased interest in sharing their knowledge about cancer with their community. Providing cancer education and leveraging a service-learning requirement led to notable changes in high school students' cancer knowledge, fear and fatalism, and risk behaviors. Students also communicated more with family/friends about cancer. Such efforts could have broader implications for student, family, and community cancer burden.

The effectiveness of patient navigation services in reducing cancer screening disparities among Asian Americans

ABSTRACT Objectives Patient navigation has served as a useful intervention to reduce cancer disparities among diverse ethnic groups. Previous studies have consistently shown the effectiveness of patient navigation in reducing cancer disparities for ethnic minorities; however, few studies have been conducted for cancer screening behaviors focusing on the Asian population. This study aims to identify the overall effectiveness of patient navigation in cancer screening behaviors among Asian Americans through meta-analyses. In addition, this study examines the moderating effects of the type of cancers on cancer screening behaviors. Design For data analyses, we selected 15 studies through a systematic review and meta-analyses, searching the databases of PubMed, Web of Science, Embase, Scopus, and Cochrane Library. Random-effects models were used for meta-analyses. Results The results showed that Asian Americans who received patient navigation were more likely to participate in cancer screening behaviors than those who did not receive patient navigation regardless of the type of cancer. Publication bias was tested using a funnel plot, meta-regression, and Failsafe-N. No notable publication bias was found. Conclusion This study can provide comprehensive evidence regarding the overall effectiveness of patient navigation in cancer screening behaviors of Asian Americans.

Cancer Disparities Experienced by People with Disabilities

People with disabilities, who represent a rapidly growing and seriously disadvantaged segment of the U.S. population, face unremitting barriers to equal and accessible healthcare and a high prevalence of chronic health conditions. A slowly growing body of research suggests multiple cancer-related disparities between people with and without disabilities. This commentary identifies multiple aspects of the cancer experience and highlights ways cancer is impacted by disability. This includes vulnerabilities to risk factors, barriers to accessing healthcare, and disparities in screening, diagnosis, and treatment. The authors offer six essential pathways for reducing cancer disparities faced by people with disabilities. It is clear that reducing cancer health disparities experienced by people with disabilities will require the commitment and cooperation of a wide range of stakeholders.