Cancer survivorship research & care最新文献

Background: It is important to understand how health behaviors, and beliefs about health behaviors and cancer risk, vary by sociodemographic factors.

Methods: The Health Information National Trends Survey - Surveillance, Epidemiology, and End Results study sampled US cancer survivors in 2021. We used weighted logistic regression to examine associations between sociodemographic factors, health behavior guideline adherence, and beliefs about health behaviors and cancer risk.

Results: Among 1134 cancer survivors, only 4% were current smokers, but 48% consumed alcohol and only 43% met aerobic exercise guidelines and 31% met strength training guidelines. Alcohol use was more common among males [vs. females, odds ratio (OR): 1.55; 95% confidence interval (CI): 1.12, 2.14], employed cancer survivors (vs. retired OR: 1.74; 95% CI: 1.07, 2.84), and those with higher incomes (<$50,000 vs. $100,000+ (ref.) OR: 0.58; 95% CI: 0.36, 0.94). Cancer survivors less likely to meet aerobic exercise guidelines included those who were not retired or employed (e.g. disabled; vs. retired OR: 0.49; 95% CI: 0.28, 0.86), with incomes <$50,000 (vs. $100,000+ OR: 95% CI: 0.50; 95% CI: 0.32, 0.78), and residing in non-metropolitan areas (vs. metropolitan with 1 + million residents, OR: 0.56; 95% CI: 0.38, 0.81). Females and retired cancer survivors were less likely to meet strength training guidelines (males vs. females (ref.) OR: 1.62; 95% CI: 1.23, 2.12; employed vs. retired (ref.) OR: 1.67; 95% CI: 1.04, 2.66). Lower education was strongly associated with beliefs that cancer risk is outside individual control (OR's: 1.73-3.85). Beliefs about health behaviors and cancer risk were not associated with health behavior guideline adherence.

Conclusions: Smoking was uncommon in this sample of cancer survivors, but many reported alcohol use and did not meet exercise guidelines. Patterns of sociodemographic factors differed by behavior. Alcohol use was more common among males and those with higher incomes. Cancer survivors with lower incomes and residing in non-metropolitan areas had the highest need for physical activity interventions.

Objective: To investigate the association between urban residential greenspace and cardiovascular disease (CVD) comorbidity at breast cancer (BC) diagnosis among older women, and explore regional, racial/ethnic, and socioeconomic differences.

Study design: This is a cross-sectional analysis of a population-based registry data.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, data on women aged 66-90 diagnosed with BC (2010-2017) were analyzed. A tract-level measure of tree canopy cover was derived from the National Landcover Database (2011) and linked to SEER-Medicare records. Logistic regression models assessed the probability of CVD comorbidity based on state-specific percent tree canopy quartiles, adjusting for census tract clustering and covariates.

Results: Out of 116,660 women, 74.7% (n=87,152) had CVD comorbidity at BC diagnosis. Overall, women residing in areas with higher percent tree canopy cover had a lower likelihood of CVD comorbidity compared to those in the lowest canopy areas, with an Adjusted Odds Ratio (AOR) and 95% confidence interval (CI) of 0.78 (0.71-0.85). Racial/ethnic, socioeconomic status (SES), and regional variations were noted. Adjusted effects of greenspace were significant only for NHW women; AOR (95%CI) = 0.78 (0.71-0.86). Women in the highest tree canopy quartile in California, New Jersey, and New Mexico had lower odds of comorbid CVD, with AORs (95% CI) of 0.80 (0.72-0.88), 0.77 (0.71-0.84), and 0.46 (0.34-0.63) respectively. Adjusted results for New York, Massachusetts, and Kentucky showed adverse harmful effects, while adjusted results for all other SEER states were not statistically significant. Both dual enrollment eligible and non-eligible women had benefits from greenspace, but greater benefits were observed in dual enrollment eligible women; AOR (95% CI)= 0.64 (0.48-0.86) versus 0.76 (0.69-0.84) for non-eligible women.

Conclusions: Overall, urban greenspace is associated with a lower risk of CVD comorbidity among older women with BC, and variations exist by region, race/ethnicity, and SES. Our findings underscore the role of greenspace in mitigating Cardio-Oncology disparities. Further research is needed to better understand factors contributing to observed differences across SEER regions and racial/ethnic subgroups. A better understanding of interactions among greenspace, other environmental factors, and individual lifestyle factors will help improve CVD outcomes among women with BC.

Background: Little research exists on delayed and forgone health and mental health care due to cost among rural cancer survivors.

Methods: We surveyed survivors in 7 primarily rural, Appalachian counties February to May 2020. Univariable analyses examined the distribution and prevalence of delayed/forgone care due to cost in the past year by independent variables. Chi-square or Fisher's tests examined bivariable differences. Logistic regressions assessed the odds of delayed/forgone care due to cost.

Results: Respondents (n=428), aged 68.6 years on average (SD: 12.0), were 96.3% non-Hispanic white and 49.8% female; 25.0% reported delayed/forgone care due to cost. The response rate was 18.5%. The proportion of delayed/forgone care for those aged 18-64 years was 46.7% and 15.0% for those aged 65+ years (P<0.0001). Females aged 65+ years (OR: 2.00; CI: 1.02-3.93) had double the odds of delayed/forgone care due to cost compared to males aged 65+ years.

Conclusion: About one in four rural cancer survivors reported delayed/forgone care due to cost, with rates approaching 50% in survivors aged <65 years.

Impact: Clinical implications indicate the need to: 1) ask about the impact of care costs, and 2) provide supportive services to mitigate effects of treatment costs, particularly for younger and female survivors.