BACKGROUND: We sought to compare time from initial abnormal breast screen to definitive diagnosis between navigated and non-navigated patients in racially/ethnically diverse Latina women in six U.S. cities. METHODS: Eligible Latinas had an abnormality of BIRADS 3, 4, or 5 detected on a mammogram, clinical breast exam, magnetic resonance imaging, or ultrasound between July 2008 and December 2010 in six U.S. cities (San Antonio, Miami, Houston, San Diego, New York, and San Francisco). Data were pooled for this analysis. Navigated patients received assistance by locally trained navigators using a patient-centered model suggested by Harold Freeman and endorsed by the Institute of Medicine. Non-navigated patient data was obtained via retrospective medical chart review. We used Log-Rank Chi-squared tests to evaluate bivariate associations with dependent variables and Kaplan-Meier and Cox Proportional Hazards analyses to compare time-to-diagnosis and timely diagnosis estimates between Navigated and Control group Latinas. RESULTS: Among 480 women with initial BIRADS 3, 4, or 5 results, follow-up data was available for 425 (88.5%). Radiologic classification of initial abnormality (BIRADS), rather than any other sociodemographic or clinical characteristic was the only significant predictor of overall and timely diagnosis. Data for women with an initial BIRADS 3 result were adjusted to control clinician-imposed diagnostic delays. Of all women, > 95% achieved definitive diagnosis within 180 days. Median time to definitive diagnosis was significantly reduced among navigated compared to non-navigated Latinas (20 days versus 27 days, hazard ratio [HR] 1.32, p = .007). This translates to a 132% increase in rates of diagnosis among navigated women. This effect was primarily observed in women with an initial BIRADS 3 result, especially when adjusted for clinically directed waiting periods between initial and follow-up screening examinations. Among navigated patients, only between-BIRADS variation rather than sociodemographic characteristics, number of barriers to care, insurance status or type or site-specific variables were associated with timely or time-to-diagnosis. CONCLUSIONS: Patient-centered navigation to assist Latina women with breast screening abnormalities reduces median time-to-diagnosis by approximately 25% when types of screening abnormality and barriers to care are addressed at patient level. Community-based interventions may be the most effective means to reduce cancer health disparities when addressing the needs of underserved populations. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4450. doi:1538-7445.AM2012-4450
Background: Breast cancer is a devastating disease. Identification of the BRCA1 and BRCA2 genetic mutations associated with it offer a potentially efficacious “early warning system.” However, investigators have expressed doubt that whether women are interested in knowing if they possess gene mutations, particularly minorities traditionally averse to dealing with a complex medical system. Additionally, effective means of addressing different levels of motivation among ethnic groups are unidentified. Here we determine the extent of interest in genetic testing among Latinas compared to non-Hispanic white (NHW) women. We also identify factors associated with interest in genetic testing. Finally, we show why differences in interest in genetic testing for breast cancer exist among groups of women. Material and Methods: We surveyed 290 women (153 Hispanic, 137 NHW) aged 26+ drawn from the catchment area of the San Antonio Cancer Therapy and Research Center. Targeted surveys included demographic information, measures assessing breast cancer knowledge, attitudes, behaviors, and medical and family history data. Based on verbal report, participants were assigned “high” or “moderate/low” cancer risk status according to American College of Medical Genetics Foundation guidelines. Pearson chi-square and student's t-tests assessed bivariate relationships. Cochran Mantel-Haenszel chi-square identified analytic strata. Multivariate logistic regression revealed factors associated with interest in genetic testing. Results: 20% of women were not “very interested” in genetic testing for the BRCA1/BRCA2 mutation. Bivariate results showed ethnicity, use of nontraditional health care sources and negative perceptions of genetic testing were associated with low interest in genetic testing among all women. A multivariate model of genetic testing interest revealed several measures significantly associated with it, including Hispanic ethnicity (OR 5.74, p<.01), routine health care from any nontraditional source, and negative perception of genetic testing (both OR 1.19, p<.03). The Hispanic result reflected reduced interested in Genetic Testing, regardless cancer risk or having had cancer [Low-risk Latinas: 75.3% v 84.9% NHW (p<.05); High-risk Latinas 75.3% v 84.9% NHW (p<.05), Cochran Mantel-Haenszel (CMH) ns.], [NoHx of Cancer Latinas 75.6% v 90.2% p<.04, Hx Cancer Latinas 72.0% v 82.9%, p<.05, CMH ns.] Given this difference we stratified our analysis. In separate multivariate models we found that NHW women are not “very interested” in genetic testing when their perception of it is negative (OR 1.36, p<.01). Latinas are significantly more likely to be interested in genetic testing when their perceived risk of breast cancer is high (OR 2.38, p<.01), and importantly, when they have biological daughters (OR 7.85, p<.001). 77.8% of Latinas with biological daughters (n = 98) compared to 55.6% of those without (n = 61) were “very interested” in genetic testing for breast cancer (p<.001). Conclusion: Genetic testing is generally acceptable to NHW and Hispanic women. However, Latinas are less likely to accept it than NHW. Whereas NHW women are influenced in their decision chiefly by use of nontraditional sources of medical care, Latinas are strongly influenced by perceptions of personal risk and having biological daughters. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A35.
Purpose: The National Cancer Institute's (NCI) Center to Reduce Cancer Health Disparities (CRCHD) has been working to strengthen community outreach capacity through Community Health Educators (CHEs) of the NCI National Outreach Network (NON). The NON CHEs, based at academic and cancer centers across the country, strengthen NCI's ability to develop and disseminate culturally appropriate, evidence-based cancer information that is tailored to the specific needs and expectations of underserved communities. Over the past five years, NON CHEs have developed, adapted, and tested community education and outreach interventions that effectively reach underserved communities to address local and regional cancer health disparity issues. Methods: A subset of NON CHEs have focused on outreach and educational interventions to reduce disparities specifically among Latino populations at high risk of cancer or cancer survivors in community settings from inner cities to rural areas. In 2010, these CHEs, based at more than 12 cancer centers and academic institutions across the country, established a working group to support one another. The NON CHE Latino Working Group shares best practices for disseminating culturally sensitive, evidence-based cancer prevention, screening, and survivorship information tailored to the specific needs of their respective Latino communities. The Latino Working Group's interventions and campaigns targeted breast, cervical, colorectal, prostate, and lung cancers, and also explored and addressed the key issue of research participation by the Latino community. The group utilized various evidence-based programs, such as the Cancer 101 curriculum and the inflatable colon. The NON CHE Latino Working Group conducted needs assessments, gathered qualitative and quantitative data to inform the adaptation of interventions, implemented and evaluated community education and outreach projects, and published findings from their work. They developed multiple educational materials, including one in collaboration with the NCI's Geographical Management of Cancer Health Disparities Program (GMaP) Region 4 program: The Clinical Trials Outreach for Latinos (CTOL): Program Replication Manual. Preliminary Results: We will present outcomes from the NON CHE Latino Working Group's diverse projects including needs assessment and intervention testing results, review feedback from focus groups conducted in the United States and Puerto Rico, discuss the success of various evidence-based programs put into practice, share information on health education classes focusing on diet and nutrition, and the community's receptivity to participate in research. We will present data collected on over 5,000 Latinos who participated in the different NON CHE programs. The NON CHE Latino WG will also discuss lessons learned, challenges and best practices. Conclusion: Although Latinos have lower incidence rates of certain cancers, they also suffer from higher mortality rates. Latino communities at risk of developing cancer and affected by cancer are often marginalized due to multiple factors and barriers, including inadequate health education, language barriers, lack of access to healthcare, and mistaken cultural beliefs about cancer. Latinos often do not engage in regular screening procedures resulting in worse health outcomes when compared to the Non-Hispanic White population. Major framework efforts, such as the established NCI/CRCHD NON CHE program, have a major impact in reducing cancer health disparities among this underserved population by offering culturally sensitive interventions that improve delivery of and/or promote practices in cancer education, prevention, screening, treatment and survivorship services. Citation Format: Sandra L. San Miguel, Alelí Ayala-Marín, Katherine J. Briant, Niyati Desai, Leticia Gatus, Diego Gómez-Aristizabal, Evelyn González, Martha E. González, Natalia I. Heredia, Nadia Lazo, Rosa Ortiz, Lizette Rangel, Yonaira Rivera, Janet Sanchez, Mayra Serrano, Rose A. Treviño Whitaker. National Outreach Network Community Health Educators: An effective framework to reduce cancer health disparities among Latinos. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A31.
Background: Latino cancer survivors experience an unequal burden of unmet needs following treatment. These include issues involving psychological issues, health care, wellness and ultimately, survival. Study Design: Redes En Acción: The National Latino Cancer Research Network and LIVESTRONG partnered to conduct a randomized control trial utilizing trained, bilingual, bicultural patient navigators to improve wellness and access to psychosocial services among non-metastatic Latino cancer survivors from Texas and Chicago. The trial tests the efficacy of patient navigation (PN) in improving general and disease-specific quality of life (QoL), treatment compliance, and identification of mechanisms that may promote quality of life. The study involves a 2 X 4 randomized repeated measures design with an experimental condition (combined PN over three months with access to the LIVESTRONG Cancer Navigation Center [LCNC] services [PN+LCNC]) versus a control condition (PN only) as the between-groups factor, and time-point (baseline/pre-randomization [T1]; post-PN [3-months post T1; T2], and 6 [T3] and 12 months [T4] follow up after T2) as the within groups factor. The unique combination of PN plus LCNC survivorship services is anticipated to show dramatic improvement in survivor-related measures. Results: LCNC provides free, bilingual support to U.S. cancer survivors throughout the cancer journey. It also refers survivors to services addressing their medical, economic and psychosocial needs, and monitors client contact and access outcomes. PN services are based on direct services provided by patient navigators, including but not limited to, securing transportation for clinic appointments, interpreting, completing complex medical forms, etc. Study implementation, needs assessment, community based participatory research, recruitment accrual to date, learned lessons, PN services offered, and referral to and effectiveness of the LCNC program and preliminary quality of life data analysis will be presented. Conclusions: Limited work has addressed the psychosocial needs of Latino cancer survivors. Culturally sensitive patient navigation (PN) could address these needs and significantly improve cancer survivorship. The results of the study will have immediate clinical relevance that could potentially highlight the importance of having patient navigators readily available to assist survivors within a clinic setting improving patients' overall health outcomes and screening compliance. Citation Format: Amelie Ramirez, Sandra L. San Miguel, Edgar Muñoz, Kip Gallion, Arely Perez, Leo Castillo, Sarah R. Arvey, Frank Penedo. Advocacy for an underserved minority: Patient navigation for Latino cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B07.
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