Association of Social Risk Factors With Mortality among Us adults With a New Cancer Diagnosis

This cohort study examines the associations of multiple social risk factors with mortality risk among patients newly diagnosed with cancer in the US

Prediction, Communication, and Distribution of Breast Cancer Risk

Thesis (Ph.D.)--University of Washington, 2012Hispanic women represent the only racial/ethnic group in the United States (US) for which breast cancer is the most frequently diagnosed cancer and leading cause of cancer deaths. Despite the availability of tools to assess breast cancer risk, relatively little is known about the performance of current breast cancer risk prediction models and distribution of breast cancer risk in Hispanic women. Furthermore, there is limited evidence on the utility of decision aids designed to help women at high risk for breast cancer make informed choices about chemoprevention. To address these gaps, the overall goal of the proposed research work was threefold: 1) evaluate breast cancer risk projections for Hispanic women; 2) assess the distribution of breast cancer risk among Hispanic women; and 3) assess the impact of a web-based, tailored decision aid for women at high risk for breast cancer. We used data from two nationally representative datasets with information on US Hispanic women, and a randomized trial of women at high risk of breast cancer. Statistical analyses included multivariate linear, logistic, and Cox regression techniques. Findings from this work contribute valuable information on the use of estimates of breast cancer risk in research, clinical practice and public health. First, the National Cancer Institute's Breast Cancer Risk Assessment Tool (BCRAT), the most widely used breast cancer risk prediction model, underestimates risk of developing invasive breast cancer in US Hispanic women. Second, the risk of developing invasive breast among Hispanic women, based on the BCRAT, is significantly lower compared to non-Hispanic white women, though breast cancer risk also significantly differs between certain Hispanic subgroups. Third, personalized decision aids may be effective tools to provide useful information about women's risk of developing specific types of breast cancer, as well as to facilitate informed medical decisions, reduce patients' decisional conflict, and empower patients to choose a treatment strategy that best reflects their own values. Together, these results improve our understanding of the prediction and distribution of breast cancer risk among US Hispanic women, and help identify ways in which breast cancer risk can be communicated to help inform women about their treatment options

Conceptions of Legacy Among People Making Treatment Choices for Serious Illness: Protocol for a Scoping Review

BackgroundLegacy—what one leaves behind and how one hopes to be remembered after death—is an unexplored and important dimension of decision-making for people facing serious illnesses. A preliminary literature review suggests that patients facing serious illness consider legacy when making medical decisions, for example, forgoing expensive treatment with limited or unknown clinical benefit to preserve one’s inheritance for their children. To date, very little is known about the conceptual foundations of legacy. No conceptual frameworks exist that provide a comprehensive understanding of how legacy considerations relate to patient choices about their medical care. ObjectiveThe objective of this scoping review is to understand the extent and type of research addressing the concept of legacy by people facing serious illness to inform a conceptual framework of legacy and patient treatment choices. MethodsThis protocol follows the guidelines put forth by Levac et al, which expands the framework introduced by Arksey and O’Malley, as well as the Joanna Briggs Institute Reviewer’s manual. This scoping review will explore several electronic databases including PubMed, Medline, CINAHL, Cochrane Library, PsycINFO, and others and will include legacy-specific gray literature, including dissertation research available via ProQuest. An initial search will be conducted in English-language literature from 1990 to the present with selected keywords to identify relevant articles and refine the search strategy. After the search strategy has been finalized, 2 independent reviewers will undertake a 2-part study selection process. In the first step, reviewers will screen article titles and abstracts to identify the eligibility of each article based on predetermined exclusion or inclusion criteria. A third senior reviewer will arbitrate discrepancies regarding inclusions or exclusions. During the second step, the full texts will be screened by 2 reviewers, and only relevant articles will be kept. Relevant study data will be extracted, collated, and charted to summarize the key findings related to the construct of legacy. ResultsThis study will identify how people facing serious illness define legacy, and how their thinking about legacy impacts the choices they make about their medical treatments. We will note gaps in the literature base. The findings of this study will inform a conceptual model that outlines how ideas about legacy impact the patient’s treatment choices. The results of this study will be submitted to an indexed journal. ConclusionsVery little is known about the role of legacy in the treatment decisions of patients across the continuum of serious illness. In particular, no comprehensive conceptual model exists that would provide an understanding of how legacy is considered by people making decisions about their care during serious illness. This study will be among the first to construct a conceptual model detailing how considerations of legacy impact medical decision-making for people facing or living with serious illnesses. International Registered Report Identifier (IRRID)DERR1-10.2196/4079

Colorectal cancer disparities in Latin America: Mortality trends 1990-2019 and a paradox association with human development.

BackgroundColorectal cancer mortality is growing in Latin America. It is known for a marked income disparity between its countries, and there is a consistent association with development. Our purpose was to describe trends in colorectal cancer mortality in Latin America between 1990 and 2019, identifying differences by human development categories.MethodsWe extracted age-adjusted mortality rate from the Global Burden of Disease (GBD) Study from 22 Latin American countries, subregions, and country groups previously ranked by the GBD study due to Sociodemographic Index (SDI) between 1990 and 2019. We applied the segmented regression model to analyze the time trend. Also, we estimated the correlation between mortality rates and Human Development Index (HDI) categories for countries.ResultsBetween 1990 and 2019, colorectal cancer adjusted mortality rate increased by 20.56% in Latin America (95% CI 19.75% - 21.25%). Between 1990 and 2004, the average annual percentage change (APC) was 0.11% per year (95% CI 0.10-0.12), and between 2004 and 2019 there was a deceleration (APC = 0.04% per year, 95% CI 0.03%- 0.05%). There is great heterogeneity among the countries of the region. Correlation between these two variables was 0.52 for 1990 and 2019. When separated into HDI groups, the correlation varied in the direction of the association and its magnitude, typifying an effect modification known as Simpson's Paradox.ConclusionsHuman development factors may be important for assessing variation in cancer mortality on a global scale. Studies that assess the social and -economic contexts of countries are necessary for robust evaluation and provision of preventive, diagnostic and curative services to reduce cancer mortality in Latin America