To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors

Compared with young White women, young Black women are more likely to present with aggressive breast cancer (BC) subtypes that are potentially linked to worse health-related quality of life (HRQOL); however, there is limited consensus regarding HRQOL needs among young Black BC survivors. Employing Ferrell's framework on QOL in BC (i.e., physical, psychological, social, and spiritual well-being), we conducted a systematic review on HRQOL among Black BC survivors aged <50 years and proposed recommendations for advancing HRQOL research and care for this population

Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD

BackgroundPrevious research demonstrated an increase in the reporting of schizophrenia diagnoses among nursing home (NH) residents after the Centers for Medicare & Medicaid Services National Partnership to Improve Dementia Care. Given known health and healthcare disparities among Black NH residents, we examined how race and Alzheimer’s and related dementia (ADRD) status influenced the rate of schizophrenia diagnoses among NH residents following the partnership.MethodsWe used a quasi- experimental difference- in- differences design to study the quarterly prevalence of schizophrenia among US long- stay NH residents aged 65- years and older, by Black race and ADRD status. Using 2011- 2015 Minimum Data Set 3.0 assessments, our analysis controlled for age, sex, measures of function and frailty (activities of daily living [ADL] and Changes in Health, End- stage disease and Symptoms and Signs scores) and behavioral expressions.ResultsThere were over 1.2 million older long- stay NH residents, annually. Schizophrenia diagnoses were highest among residents with ADRD. Among residents without ADRD, Black residents had higher rates of schizophrenia diagnoses compared to their nonblack counterparts prior to the partnership. Following the partnership, Black residents with ADRD had a significant increase of 1.7% in schizophrenia as compared to nonblack residents with ADRD who had a decrease of 1.7% (p = 0.007).ConclusionsFollowing the partnership, Black NH residents with ADRD were more likely to have a schizophrenia diagnosis documented on their MDS assessments, and schizophrenia rates increased for Black NH residents with ADRD only. Further work is needed to examine the impact of - colorblind- policies such as the partnership and to determine if schizophrenia diagnoses are appropriately applied in NH practice, particularly for black Americans with ADRD.See related editorial by Rhodes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171195/1/jgs17464.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171195/2/jgs17464_am.pd

Trends in antipsychotic prescribing among long‐term care residents receiving hospice care

ImportanceThe Centers for Medicare & Medicaid Services’ (CMS) National Partnership to Improve Dementia Care in Nursing Homes (“CMS National Partnership”) focuses on reducing antipsychotic prescribing to long‐term care residents. Hospice enrollment is not an exclusionary condition for the antipsychotic quality measure reported by CMS. It is unclear how prescribing in hospice may have been impacted by the initiative.ObjectiveEstimate the association of the CMS National Partnership with trends in antipsychotic prescribing among long‐term care residents in hospice.DesignInterrupted time‐series analysis of a 100% Minimum Data Set sample with linked hospice claims from 2011 to 2017.SettingLong‐term care nursing facilities.ParticipantsOlder adults ≥65 residing in long‐term care (n = 3,741,379) and limited to those enrolled in hospice (n = 821,610).Main outcomeQuarterly prevalence of antipsychotic and other psychotropic (antianxiety, hypnotic, antidepressant) use among long‐term care residents; overall and among residents with dementia, stratified by hospice enrollment.ResultsFrom 2011 to 2017, parallel declines in antipsychotic prescribing were observed among long‐term care residents enrolled and not enrolled in hospice (hospice: decline from 26.8% to 18.7%; non‐hospice: decline from 23.0% to 14.4%). Following the 2012 CMS National Partnership, quarterly rates of antipsychotic prescribing declined significantly for both residents enrolled and not enrolled in hospice care. Declines in antipsychotic prescribing were greater for residents with dementia, with similar rates among residents enrolled and not enrolled in hospice. Among residents with dementia enrolled in hospice, use of other psychotropic medication classes including antianxiety, antidepressant, and hypnotic use remained relatively stable over time.Conclusions and relevanceDeclines in antipsychotic prescribing during the CMS National Partnership occurred among long‐term care residents in hospice, where use may be deemed clinically appropriate. Nursing homes are an important location for the provision of dementia end‐of‐life care and the drivers of potentially unintended reductions in antipsychotic use merits further investigation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/169272/1/jgs17172_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169272/2/jgs17172.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/169272/3/jgs17172-sup-0001-supinfo.pd

To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors

PURPOSE: Compared with young White women, young Black women are more likely to present with aggressive breast cancer (BC) subtypes that are potentially linked to worse health-related quality of life (HRQOL); however, there is limited consensus regarding HRQOL needs among young Black BC survivors. Employing Ferrell's framework on QOL in BC (i.e., physical, psychological, social, and spiritual well-being), we conducted a systematic review on HRQOL among Black BC survivors aged <50 years and proposed recommendations for advancing HRQOL research and care for this population. METHODS: Literature searches were conducted in MED-LINE/PubMed, EMBASE, CINAHL, and PsycINFO to identify relevant articles published from 1995 to 2015. Abstracts and full-text articles were screened using predetermined inclusion/exclusion criteria and evaluated for quality. RESULTS: A total of 2533 articles were identified, but six met eligibility criteria. Most studies examined multiple HRQOL domains, with the psychological domain most represented. Compared with their older, White, and BC-free counterparts, young Black BC survivors reported greater fear of dying, unmet supportive care needs, financial distress, and lower physical/functional well-being. However, spiritual well-being appeared favorable for young Black survivors. Research gaps include the absence of longitudinal studies and under-representation of studies examining physical, social, and particularly, spiritual HRQOL in young Black BC survivors. CONCLUSIONS: Young Black BC survivors generally experience suboptimal HRQOL after BC diagnosis. As few studies have reported on HRQOL among this group, future research and oncology care should prioritize young Black women in ways that recognize their unique concerns, in order to ensure better HRQOL outcomes both during and after treatment