Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 39 Records) |
Query Trace: Townsend JS[original query] |
---|
Melanoma incidence rates among Non-Hispanic American Indian/Alaska Native Individuals, 1999-2019
Townsend JS , Melkonian SC , Jim MA , Holman DM , Buffalo M , Julian AK . JAMA Dermatol 2023 IMPORTANCE: Non-Hispanic American Indian/Alaska Native people have the second highest incidence rate of invasive cutaneous melanoma in the US after non-Hispanic White people. OBJECTIVE: To examine invasive cutaneous melanoma incidence rates and trends over time among non-Hispanic American Indian/Alaska Native people. DESIGN, SETTING, AND PARTICIPANTS: This descriptive, observational cross-sectional study used population-based cancer registry data (US Cancer Statistics AI/AN Incidence Analytic Database) linked to the Indian Health Service administrative database to examine incidence rates by age, sex, region, histology, tumor site, stage, and other demographic and clinical characteristics. The study examined trends from 1999 to 2019 time period by age, sex, stage at diagnosis, and region. Non-Hispanic American Indian/Alaska Native people 15 years and older who received a diagnosis of invasive cutaneous melanoma from 1999 to 2019 who were members of federally recognized tribes and resided in Indian Health Service purchased/referred care delivery areas were included in this study to reduce racial misclassification and provide more accurate rates. The data were analyzed in 2022. EXPOSURES: Demographic and clinical characteristics, such as age, sex, geographic region, histology, stage, and tumor site. MAIN OUTCOMES AND MEASURES: Invasive cutaneous melanoma incidence rates by age group, sex, region, resident county characteristics (poverty level, rurality, education level, and socioeconomic status), stage at diagnosis, tumor site, and histology. Trends over time by age, sex, region, and stage. RESULTS: From 1999 to 2019, 2151 non-Hispanic American Indian/Alaska Native people (1021 female individuals [47.5%]) received a diagnosis of incident cutaneous melanoma (rate, 10.7 per 100 000; 95% CI, 10.3-11.2). Rates were higher among male than female individuals (13.0 [95% CI, 12.2-13.8] vs 9.2 [95% CI, 8.6-9.8]) and for people 55 years and older (24.2; 95% CI, 22.8-25.7) compared with those aged 15 to 39 years (3.5; 95% CI, 3.2-3.9). Rates were highest for male individuals 55 years and older (34.5; 95% CI, 31.8-37.3) and people living in the Southern Plains (male individuals: 23.8; 95% CI, 21.5-26.2; female individuals: 15.5; 95% CI, 14.0-17.2) and Pacific Coast region (male individuals: 16.5; 95% CI, 14.5-18.7; female individuals: 12.3; 95% CI, 10.9-13.9). Rates increased among female individuals from 1999 to 2019 (average annual percent change [AAPC], 2.5; P < .001); among regional/distant stage tumors (AAPC, 2.5; P = .01) and people 55 years and older (AAPC, 2.8; P = .001). CONCLUSIONS AND RELEVANCE: The results of this study suggest that additional studies could potentially identify risk factors among non-Hispanic American Indian/Alaska Native people. |
Reducing cancer risk through primary prevention activities among children: A demonstration project
Tai E , Chovnick G , Momin B , Townsend JS , Holman DM , Siegel D , House M . J Public Health Manag Pract 2023 CONTEXT: Opportunities to reduce the risk of cancer, including cervical, liver, and skin cancer, start early in life. To encourage adoption of primary prevention activities in childhood to reduce cancer risk later in life, Centers for Disease Control and Prevention conducted a demonstration project with 3 National Comprehensive Cancer Control Program (NCCCP) recipients. PROGRAM: Iowa, Northwest Portland Area Indian Health Board (NPAIHB), and Pennsylvania NCCCP recipients implemented evidence-based primary prevention activities for cervical, liver, and skin cancer among children using health care provider education, patient education, and policy development. IMPLEMENTATION: Iowa implemented an announcement approach to improve provider education on human papillomavirus (HPV) vaccination. Pennsylvania focused on patient education for reducing skin cancer risk and both provider and patient education for liver cancer prevention. NPAIHB created a sun safety intervention for tribal organizations, including a policy guide, media materials, and patient education. RESULTS: In Iowa, health care providers taking the announcement approach reported significantly higher mean scores on a posttest compared with a pretest regarding perceptions about HPV vaccination, self-efficacy, and behavioral intentions related to vaccination. Pennsylvania integrated sun safety education and sunscreen dispenser programs as a health and wellness initiative in 8 state parks and the Pennsylvania Department of Conservation and Natural Resources incorporated the program in its Pennsylvania Outdoor Recreation Plan. Pennsylvania also implemented health care provider education on the primary prevention of liver cancer through hepatitis B and hepatitis C screening and hepatitis B vaccination. The NPAIHB skin cancer policy guide was created and distributed for use to all 43 federally recognized tribes of Oregon, Washington, and Idaho served by NPAIHB. DISCUSSION: The identification, dissemination, and implementation of these efforts can serve as best practices for future childhood primary prevention programs. NCCCP recipients and public health professionals can use health care provider education, patient education, and policy development to reduce future risk for cervical, liver, and skin cancer among children. |
Use of cancer survivorship care guidelines by primary care providers in the United States
Townsend JS , Rohan EA , Sabatino SA , Puckett M . J Am Board Fam Med 2023 36 (5) 789-802 BACKGROUND: National organizations have issued comprehensive cancer survivorship care guidelines to improve care of cancer survivors, many of whom receive care from primary care providers (PCPs). METHODS: We analyzed Porter Novelli's 2019 fall DocStyles survey to assess use of cancer survivorship care guidelines, receipt of survivorship training, types of survivorship services provided, and confidence providing care among PCPs in the United States. We grouped PCPs by use of any guideline ("users") versus no guideline use ("nonusers"). We calculated descriptive statistics and conducted multivariable logistic regression analyses to examine guideline use, having received training on providing survivorship care services, and confidence in providing care. Within the panel, sampling quotas were set so that 1000 primary care physicians, 250 OB/GYNs, 250 pediatricians, and 250 nurse practitioners/physician assistants were recruited. RESULTS: To reach selected quotas, 2696 health professionals were initially contacted to participate, resulting in a response rate of 64.9%. Sixty-two percent of PCPs reported using guidelines and 17% reported receiving survivorship care training. Use of any guidelines or receiving training was associated with reporting providing a range of survivorship services and confidence in providing care. After adjusting for demographic characteristics, guideline users were more likely than nonusers to report assessing genetic cancer risk (OR = 2.65 95% confidence interval (CI) (1.68, 4.17)), screening for cancer recurrence (OR = 2.32 95% CI (1.70, 3.18)) or a new cancer (OR = 1.63, 95% CI (1.20, 2.22)), and treating depression (OR = 1.64, 95% CI (1.20, 2.25)). Receipt of training was also positively associated with providing genetic risk assessment, surveillance for recurrence, as well as assessing late/long-term effects, and treating pain, fatigue, and sexual side effects. CONCLUSION: Survivorship care guidelines and training support PCPs in providing a range of survivorship care services. |
2020 cancer incidence data in the USA reveal effects of the COVID-19 pandemic
Townsend JS . Lancet Oncol 2023 24 (8) 825-826 Routine screening for breast, cervical, and colorectal cancers decreased substantially after the COVID-19 public health emergency was declared in early 2020.1, 2 This decrease was largely due to facility closures, local policies to limit viral spread, and cancelation of non-emergency procedures.1, 2 Screening generally rebounded later in 2020, but not uniformly across all areas of the USA or segments of the population.1, 2 Some people might have also delayed seeking medical care during the height of the pandemic for symptoms suggestive of cancer because of concerns regarding contact with SARS-CoV-2.3 | | 3 years after the start of the pandemic, US nationwide cancer incidence data are starting to reveal its impact on cancer diagnoses. In The Lancet Oncology, a study by Xuesong Han and colleagues assessed data from the US Commission on Cancer's National Cancer Database, including the recently released 2020 dataset.4 The authors found a 17·2% reduction in stage I cancers diagnosed in 2020 compared with 2019 (278 400 cases in 2020 vs 336 136 in 2019). Diagnoses of stage IV cancers decreased by 9·8% (148 339 in 2020 vs 164 545 in 2019). However, the odds of having a cancer diagnosed as stage IV in 2020 increased by about 7% compared with 2019 (adjusted odds ratio [aOR] 1·074 [1·066–1·083] for stage IV vs stage I–III). |
A Case Study of Early-Onset Colorectal Cancer: Using Electronic Health Records to Support Public Health Surveillance on an Emerging Cancer Control Topic
Townsend JS , Jones MC , Jones MN , Waits AW , Konrad K , McCoy NM . J Registry Manag 2021 48 (1) 4-11 Electronic health records (EHRs) are increasingly being used to support public health surveillance, including in cancer, where many population-based registries can now accept electronic case reporting. Using EHRs to supplement cancer registry data provides the opportunity to examine in more detail emerging issues in cancer control, such as the increasing incidence rates of early onset colorectal cancer (CRC). The purpose of this study was to evaluate the feasibility of a public health organization partnering with a health system to examine risk factors for early-onset CRC in a community cancer setting, and to further understand challenges with using EHRs to address emerging topics in cancer control. We conducted a mixed-methods evaluation using key informant interviews with public health practitioners, researchers, and registry staff to generate insights on how using EHRs and partnering with health systems can improve chronic disease surveillance and cancer control. A data quality assessment of variables representing risk factors for CRC and other clinical characteristics was conducted on all CRC patients diagnosed in 2016 at the participating cancer center. The quantitative assessment of the EHR data revealed that, while most chronic health conditions were well documented, around 25% of CRC patients were missing information on body mass index, alcohol, and tobacco use. Key informants offered ideas and ways to overcome challenges with using EHR data to support chronic disease surveillance. Their recommendations included the following activities: engaging EHR vendors in the development of standards, taking leadership roles on workgroups to address emerging technological issues, participating in pilot studies and task forces, and negotiating with EHR vendors so that clinical decision support tools built to support public health initiatives are freely available to all users of those EHRs. Although using EHR data to support public health efforts is not without its challenges, it soon could be an important part of chronic disease surveillance and cancer control. |
Translating an economic analysis into a tool for public health resource allocation in cancer survivorship
Rivers Z , Roth JA , Wright W , Rim SH , Richardson LC , Thomas CC , Townsend JS , Ramsey SD . MDM Policy Pract 2023 8 (1) 23814683231153378 Background. The complexity of decision science models may prevent their use to assist in decision making. User-centered design (UCD) principles provide an opportunity to engage end users in model development and refinement, potentially reducing complexity and increasing model utilization in a practical setting. We report our experiences with UCD to develop a modeling tool for cancer control planners evaluating cancer survivorship interventions. Design. Using UCD principles (described in the article), we developed a dynamic cohort model of cancer survivorship for individuals with female breast, colorectal, lung, and prostate cancer over 10 y. Parameters were obtained from the National Program of Cancer Registries and peer-reviewed literature, with model outcomes captured in quality-adjusted life-years and net monetary benefit. Prototyping and iteration were conducted with structured focus groups involving state cancer control planners and staff from the Centers for Disease Control and Prevention and the American Public Health Association. Results. Initial feedback highlighted model complexity and unclear purpose as barriers to end user uptake. Revisions addressed complexity by simplifying model input requirements, providing clear examples of input types, and reducing complex language. Wording was added to the results page to explain the interpretation of results. After these updates, feedback demonstrated that end users more clearly understood how to use and apply the model for cancer survivorship resource allocation tasks. Conclusions. A UCD approach identified challenges faced by end users in integrating a decision aid into their workflow. This approach created collaboration between modelers and end users, tailoring revisions to meet the needs of the users. Future models developed for individuals without a decision science background could leverage UCD to ensure the model meets the needs of the intended audience. HIGHLIGHTS: Model complexity and unclear purpose are 2 barriers that prevent lay users from integrating decision science tools into their workflow.Modelers could integrate the user-centered design framework when developing a model for lay users to reduce complexity and ensure the model meets the needs of the users. |
Computable guidelines and clinical decision support for cervical cancer screening and management to improve outcomes and health equity
Saraiya M , Colbert J , Bhat GL , Almonte R , Winters DW , Sebastian S , O'Hanlon M , Meadows G , Nosal MR , Richards TB , Michaels M , Townsend JS , Miller JW , Perkins RB , Sawaya GF , Wentzensen N , White MC , Richardson LC . J Womens Health (Larchmt) 2022 31 (4) 462-468 Cervical cancer is highly preventable when precancerous lesions are detected early and appropriately managed. However, the complexity of and frequent updates to existing evidence-based clinical guidelines make it challenging for clinicians to stay abreast of the latest recommendations. In addition, limited availability and accessibility to information technology (IT) decision supports make it difficult for groups who are medically underserved to receive screening or receive the appropriate follow-up care. The Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control (DCPC), is leading a multiyear initiative to develop computer-interpretable ("computable") version of already existing evidence-based guidelines to support clinician awareness and adoption of the most up-to-date cervical cancer screening and management guidelines. DCPC is collaborating with the MITRE Corporation, leading scientists from the National Cancer Institute, and other CDC subject matter experts to translate existing narrative guidelines into computable format and develop clinical decision support tools for integration into health IT systems such as electronic health records with the ultimate goal of improving patient outcomes and decreasing disparities in cervical cancer outcomes among populations that are medically underserved. This initiative meets the challenges and opportunities highlighted by the President's Cancer Panel and the President's Cancer Moonshot 2.0 to nearly eliminate cervical cancer. |
Still lost in transition Perspectives of ongoing cancer survivorship care needs from comprehensive cancer control programs, survivors, and health care providers
Ross LW , Townsend JS , Rohan EA . Int J Environ Res Public Health 2022 19 (5) Public health agencies have played a critical role in addressing the complex health and mental health needs of cancer survivors. We conducted a mixed-methods evaluation via a Web-based survey (n = 51) and focus groups (n = 11) with National Comprehensive Cancer Control Program (NCCCP) recipients and interviews (n = 9) with survivors, health care providers (HCPs), and patient navigators to explore these audiences' cancer survivorship information needs and strategies to improve resource dissemination. Participants revealed a need for tailored resources and support for survivors on healthy lifestyle, post-treatment survivorship concerns, psychosocial health, and navigating the health system. HCP needs included education on survivorship care plans and care coordination to facilitate the transition between oncology and primary care. HCPs were survivors' most trusted source for information; however, participants noted difficulties engaging HCPs in survivorship care. These findings can help public health practitioners focus their efforts to better meet the needs of cancer survivors and their HCPs. |
Pain among cancer survivors
Gallaway MS , Townsend JS , Shelby D , Puckett MC . Prev Chronic Dis 2020 17 E54 INTRODUCTION: Pain is one of the most common symptoms that people with cancer experience. Identification of demographic, physiologic, and behavioral correlates of pain among cancer survivors could help identify subgroups most in need of pain management. METHODS: We analyzed data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System Cancer Survivorship Optional Module, which was completed by 18 states and territories, to describe demographic and physiologic characteristics of cancer survivors reporting physical pain caused by cancer or cancer treatment. Adjusted and unadjusted population-based estimates and 95% confidence intervals were calculated. RESULTS: Of 12,019 cancer survivor respondents, 9.5% reported current pain related to cancer or cancer treatment. Current pain differed significantly by sex, race/ethnicity, age, and cancer type. Current pain was reported most often among survivors with more than 3 chronic diseases (16.7%) compared with survivors with none (8.1%) or 1 or 2 (10.0%). Pain was higher among survivors reporting fair or poor general health (18.0%) than among survivors reporting otherwise, and higher among survivors reporting more than 14 days of poor physical health (16.6%) or poor mental health (14.8%) compared with less than 14 days (in the past 30 days). CONCLUSIONS: Our results suggest that approximately 10% of cancer survivors in the United States are experiencing pain that may have persisted for years after their initial diagnosis and may not be adequately controlled. Increasing knowledge of the most appropriate pain management planning and strategies for controlling short- and long-term chronic pain among cancer survivors could help reduce the prevalence of pain. |
Survivorship objectives in comprehensive cancer control plans: a systematic review
Mollica MA , Falisi AL , Geiger AM , Jacobsen PB , Lunsford NB , Pratt-Chapman ML , Townsend JS , Nekhlyudov L . J Cancer Surviv 2020 14 (2) 235-243 PURPOSE: Over a decade ago, the National Academy of Medicine (NAM) recommended that states develop, implement, and evaluate plans that include consideration of survivorship care. The purpose of this study was to review comprehensive cancer control plans in the USA, specifically to identify the inclusion of cancer survivorship-focused goals and objectives and examine alignment of survivorship-focused objectives with the NAM recommendations. METHODS: Plans from 50 states, 7 territories, 5 tribal organizations, and the District of Columbia were reviewed to assess inclusion of survivorship goals and objectives. One territory plan was excluded because it did not include a survivorship-focused goal or objective (final n = 62). Objectives were assigned to domains based on NAM survivorship recommendations. RESULTS: Plans included between 1 and 19 survivorship-related objectives. Of the 345 survivorship objectives extracted and analyzed, the most prevalent domains addressed were raising awareness, survivorship care plans, healthcare professional capacity, and models of coordinated care. Employment-related concerns, developing and implementing quality measures, and investments in research were not frequently included in objectives. CONCLUSIONS: Comprehensive cancer control plans represent an important strategy that may reduce the impact of cancer and its treatment. State, territorial, and tribal coalitions can use these results to systematically focus future survivorship efforts on areas relevant to their region and population. IMPLICATIONS FOR CANCER SURVIVORS: The growing number of survivors requires broad-ranging policy strategies. Future efforts are needed to assess the implementation and impact of plan strategies to improve the overall wellness of cancer survivors. |
Evaluating the Feasibility of Using a Mobile App to Track Oncology Patient Navigation Activities and Outcomes
Rohan EA , Slotman B , Tristani EG , Townsend JS , White DE , Fultz-Butts K , Gardner A . J Oncol Navig Surviv 2019 10 (3) 98-104 BACKGROUND: The Centers for Disease Control and Prevention supports the implementation of evidence-based interventions to prevent and control cancer, including patient navigation (PN); however, PN lacks standardized tools to measure effectiveness and aggregate data across programs. Using a mobile application (app) could provide a systematic infrastructure for cataloging PN activities and measuring patient outcomes. OBJECTIVE: Our goal was to evaluate the feasibility of using a mobile app to assist with PN services within cancer control programs. METHODS: Seven navigators in 6 geographically diverse PN programs evaluated the mobile app over a period of 5 to 9 months by using the app to track their daily activities. We evaluated the app's capability for collecting and reporting core data elements, such as time spent on outreach, patient care, and administrative tasks, as well as standardized metrics for program evaluation and monitoring. We obtained qualitative data during calls with the navigators through weekly journals and in-depth interviews. RESULTS: The app was effective in tracking caseload, profiling patients' health challenges and barriers to screening and treatment, and capturing PN activities performed during patient encounters. App limitations included an unreliable reporting function, a requirement for internet connectivity, patient privacy concerns, and evolving technology. DISCUSSION: Lessons learned from this evaluation will be useful in developing an app with more robust capabilities while retaining user-friendly features. CONCLUSION: Mobile technology may reduce individual and health system barriers to accessing cancer care and treatment and support posttreatment cancer survivors while also assisting navigators in conducting their work efficiently and effectively. |
An exploration of patient navigation and community health worker activities across national comprehensive cancer control programs
Rohan EA , McDougall R , Townsend JS . Health Equity 2018 2 (1) 366-374 Purpose: Health disparities persist across the cancer care continuum. Patient navigator (PN) and community health worker (CHW) interventions are designed to increase health equity. National Comprehensive Cancer Control Program (NCCCP) awardees develop and implement plans to coordinate cancer prevention and control activities, including supporting PN and CHW interventions. This content analysis examined NCCCP action plans to assess the extent to which jurisdictions report engaging in PN and/or CHW activities. Methods: We abstracted PN and CHW content from NCCCP action plans and coded content according to specific areas of PN and/or CHW intervention (e.g., screening, survivorship, and cancer type), used descriptive statistics to characterize overall results, and calculated chi-squares to determine whether programs engaged PNs and CHWs differently. Results: Eighty-two percent (n=53) of 65 NCCCP action plans had content related to PN and/or CHW activities, with more PN language (83%) than CHW (58%). These action plans described engaging PNs and CHWs in activities across the cancer continuum, but particularly for screening (60%) and survivorship (55%). Eighty-one percent of these plans described activities related to workforce development, such as training and standardizing roles and competencies. Programs engaged CHWs more often than PNs for outreach and in community settings. Conclusion: The majority of NCCCP awardees reported engaging in PN and/or CHW activities. Understanding how NCCCP awardees engage PNs and CHWs, including awardees' needs for workforce development in this area, can help Centers for Disease Control and Prevention provide more focused technical assistance as programs increase engagement of PNs and CHWs to improve health equity. |
Advancing health equity through the National Comprehensive Cancer Control Program
Momin B , Wanliss E , Davis L , Townsend JS , Lopez K , Steele B . Cancer Causes Control 2018 29 (12) 1231-1237 Achieving health equity requires addressing social determinants of health. Promoting health equity as it relates to cancer control is one of six priorities of the National Comprehensive Cancer Control Program (NCCCP). This article describes recent activities implemented by three NCCCP awardees (North-west Portland Area Indian Health Board, Kansas, Michigan) and the CDC-funded National Behavior Health Network (NBHN), whose aim is to reduce health disparities among those with mental health and/or substance disorders. North-west Portland administered tribal surveys to help better understand tribal cancer-related risk factors, health behaviors, provide baseline data to support their cancer plan, and obtain resources for targeted interventions. Kansas established a health equity workgroup with a vision of addressing health equity through implementation and uptake of activities among all Kansans. Michigan provided trainings in health equity and social justice and developed health equity learning labs. As a result of the successful implementation of the NBHN's Community of Practice, individuals currently living with mental illness and/or substance disorders have had increased access to tobacco cessation and other cancer support services. These efforts and key opportunities for public health practitioners and their partners to increase engagement in cancer health equity are summarized in this article. |
Capacity building for and implementation of policy, systems, and environmental change: Results from a survey of the National Comprehensive Cancer Control Program
Townsend JS , Sitaker M , Rose JM , Rohan EA , Gardner A , Moore AR . Popul Health Manag 2018 22 (4) 330-338 Policy, systems, and environmental (PSE) approaches are commonly used to improve population health. Cancer-related examples include providing data and education to stakeholders about policies that support healthy living, or health systems changes such as universal reminders about recommended cancer screening. The National Comprehensive Cancer Control Program (NCCCP) funds health departments to form cancer coalitions that develop and implement cancer plans. NCCCP initiated a demonstration program in 13 of 65 funded grantees to determine whether skilled, dedicated staffing and using a strategic process to examine data, form a workgroup, and develop an agenda would enhance their capacity to implement PSE approaches, recruit new partners, and provide data and education to stakeholders. The objective of this study was to compare demonstration program grantees to other NCCCP grantees on their ability to develop and implement PSE strategies, and the short-term results that were achieved. Program directors (PDs) from each NCCCP-funded jurisdiction completed web surveys at 2 time points during implementation to assess changes in their capacity for PSE approaches, identify implementation activities, and document short-term outcomes. Responses from demonstration program PDs and other PDs at both time points were compared in a descriptive analysis. Demonstration program grantees experienced greater increases in skills and capacity to address PSE approaches, engaged in necessary implementation activities more often, and achieved greater improvements in stakeholder and decision maker awareness and support for PSE strategies, compared to nonparticipating NCCCP grantees. These findings support continued implementation of PSE approaches for sustainable cancer prevention and control. |
Prioritizing population approaches in cancer prevention and control: Results of a case study evaluation of policy, systems, and environmental change
Rohan EA , Chovnick G , Rose J , Townsend JS , Young M , Moore AR . Popul Health Manag 2018 22 (3) 205-212 Development and implementation of policy, systems, and environmental (PSE) change is a commonly used public health approach to reduce disease burden. The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program conducted a demonstration with 13 programs to determine whether and to what extent dedicated resources would enhance the adoption of PSE strategies. This paper describes results of the qualitative portion of a longitudinal, mixed-methods evaluation of this demonstration. Case studies were conducted with a diverse subset of the 13 programs, and 106 in-depth interviews were completed with state/tribal program staff, community partners, and decision makers. Interviews addressed PSE change planning and capacity building, partnerships, local context, and how programs achieved PSE change. Dedicated PSE resources, including a policy analyst, helped increase PSE change capacity, intensify focus on PSE change overall, and accomplish specific PSE changes within individual jurisdictions. Stakeholders described PSE change as a gradual process requiring preparation and prioritization, strategic collaboration, and navigation of local context. Findings suggest that the demonstration program, including PSE-dedicated funds and a policy analyst, was successful in both increasing PSE change capacity and achieving PSE change itself. These results may be useful to other state, tribal, territorial, and public health organizations planning or implementing PSE change strategies. |
Improving knowledge and awareness of human papillomavirus-associated gynecologic cancers: Results from the National Comprehensive Cancer Control Program/Inside Knowledge Collaboration
Townsend JS , Puckett M , Gelb CA , Whiteside M , Thorsness J , Stewart SL . J Womens Health (Larchmt) 2018 27 (8) 955-964 BACKGROUND: Over 16,000 women are diagnosed with a human papillomavirus (HPV)-associated gynecologic cancer every year. Because most of these cancers are preventable, correct and appropriate information about the HPV vaccine and cervical cancer screening can help reduce incidence. MATERIALS AND METHODS: The Centers for Disease Control and Prevention created Inside Knowledge: Get the Facts About Gynecologic Cancer campaign materials, which were used by seven National Comprehensive Cancer Control Program recipients in tailored educational sessions on gynecologic cancer with women and healthcare providers in the community setting. Session participants completed presession and postsession questionnaires. Differences in knowledge and intentions were assessed using chi-square tests for women in the general public, obstetricians/gynecologists (OB/GYNs), primary care physicians (PCPs), and other healthcare providers. RESULTS: Women's knowledge improved significantly presession to postsession that HPV causes vaginal (39%-65%, p < 0.001) and vulvar cancers (26%-60%, p < 0.001), but postsession few women correctly identified all HPV-associated gynecologic cancers (15%). From presession to postsession, more women were able to correctly identify recommended age groups for whom the HPV vaccine is recommended (15%-30%, p < 0.001), and that the Pap test only screens for cervical cancer (58%-73%, p < 0.001). Among providers, OB/GYNs had more baseline knowledge of HPV-associated gynecologic cancers than other providers. Postsession, PCPs and other providers increased their knowledge of HPV vaccine recommended age groups (33%-71% and 23%-61%, respectively), and the 3-year recommended screening interval for the Pap test (73%-91% and 63%-85%, respectively). HPV vaccine knowledge did not show significant improvement among OB/GYNs postsessions. CONCLUSIONS: Women and healthcare providers who attended the Inside Knowledge sessions significantly improved their knowledge of HPV-associated gynecologic cancers. Additional educational activities during the sessions that support distinguishing between HPV-associated versus other gynecologic cancers and clarify HPV vaccine recommendations may help with further increases in knowledge. |
Cervical cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study
Benard VB , Watson M , Saraiya M , Harewood R , Townsend JS , Stroup AM , Weir HK , Allemani C . Cancer 2017 123 Suppl 24 5119-5137 BACKGROUND: Overall, cervical cancer survival in the United States has been reported to be among the highest in the world, despite slight decreases over the last decade. Objective of the current study was to describe cervical cancer survival trends among US women and examine differences by race and stage. METHODS: This study used data from the CONCORD-2 study to compare survival among women (aged 15-99 years) diagnosed in 37 states covering 80% of the US population. Survival was adjusted for background mortality (net survival) with state- and race-specific life tables and was age-standardized with the International Cancer Survival Standard weights. Five-year survival was compared by race (all races, blacks, and whites). Two time periods, 2001-2003 and 2004-2009, were considered because of changes in how the staging variable was collected. RESULTS: From 2001 to 2009, 90,620 women were diagnosed with invasive cervical cancer. The proportion of cancers diagnosed at a regional or distant stage increased over time in most states. Overall, the 5-year survival was 63.5% in 2001-2003 and 62.8% in 2004-2009. The survival was lower for black women versus white women in both calendar periods and in most states; black women had a higher proportion of distant-stage cancers. CONCLUSIONS: The stability of the overall survival over time and the persistent differences in survival between white and black women in all US states suggest that there is a need for targeted interventions and improved access to screening, timely treatment, and follow-up care, especially among black women. Cancer 2017;123:5119-37. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. |
Healthcare access and cancer screening among victims of intimate partner violence
Massetti GM , Townsend JS , Thomas CC , Basile KC , Richardson LC . J Womens Health (Larchmt) 2017 27 (5) 607-614 BACKGROUND: Intimate partner violence (IPV) victims often experience substantial and persistent mental and physical health problems, including increased risk for chronic disease and barriers to healthcare access. This study investigated the association between IPV and cancer screening. MATERIALS AND METHODS: Behavioral Risk Factor Surveillance System data from the eight states and one U.S. territory that administered the optional IPV module in 2006 were analyzed to examine demographic characteristics, health behaviors, health status, healthcare coverage, use of health services, and cancer screening among men and women who reported IPV victimization compared with those among men and women who did not. IPV victimization included physical violence, threats, and sexual violence. RESULTS: In the nine jurisdictions that administered the IPV module, 23.6% of women and 11.3% of men experienced IPV. Fewer women and men reporting IPV victimization had health insurance, a personal doctor or healthcare provider, or regular checkups within the past 2 years than nonvictims. More male and female IPV victims were current tobacco users and engaged in binge drinking in the past month. IPV victims of both sexes also had poorer health status, lower life satisfaction, less social and emotional support, and more days with poor physical and mental health in the past month than nonvictims. IPV victimization was associated with lower rates of mammography and colorectal cancer screening but not cervical cancer screening in women and was not associated with colorectal cancer screening in men. In multivariable logistic regression results presented as adjusted proportions controlling for demographics, health status, and healthcare access, only the association with mammography screening remained significant, and the magnitude of this association was modest. CONCLUSIONS: There were consistent differences between IPV victims and nonvictims in nearly every measure of healthcare access, health status, and preventive service use. Much of this association seems explained by population characteristics associated with both IPV and lower use of preventive service use, including differences in demographic characteristics, health status, and healthcare access. Healthcare providers could take steps to identify populations at high risk for lack of access or use of preventive services and IPV victimization. |
Ovarian cancer knowledge in women and providers following education with Inside Knowledge Campaign materials
Puckett MC , Townsend JS , Gelb CA , Hager P , Conlon A , Stewart SL . J Cancer Educ 2017 33 (6) 1285-1293 Because no effective methods for preventing or screening for ovarian cancer exist, symptom recognition is integral to its early detection. The Centers for Disease Control and Prevention's Inside Knowledge: Get the Facts about Gynecologic Cancer campaign was developed to raise awareness and educate women and providers about risk factors, symptoms, recommended screening, and prevention strategies for the five main gynecologic cancers, including ovarian cancer. Inside Knowledge campaign materials were utilized by CDC's National Comprehensive Cancer Control Program grantees to educate women and providers about gynecologic cancer from 2014 to 2015. Grantees recruited participants and held educational sessions using Inside Knowledge materials. Questionnaires were given before and after the sessions to assess changes in awareness, confidence, and behavioral intentions around gynecologic cancer information and analyzed in 2016. This analysis focused on an assessment of changes related to ovarian cancer information. Participants' knowledge increased after educational sessions. Among women, there were increases in correctly identifying that the Papanicolaou (Pap) test does not screen for ovarian cancer (89.2%) and that genetic testing is available (77.9%). There was a lower increase in knowledge that HPV is not a cause of ovarian cancer (56.4%). Providers and women reported significant increases in their confidence in their ability to talk to each other about gynecologic cancer post-session. Ovarian cancer awareness, confidence, and related behaviors increased in participants exposed to Inside Knowledge materials. Using these materials to increase knowledge could lead to more empowered patients, better provider-patient communications, and improved care for gynecologic cancers, including ovarian cancer. |
Human papillomavirus vaccine as an anticancer vaccine: Collaborative efforts to promote human papillomavirus vaccine in the National Comprehensive Cancer Control Program
Townsend JS , Steele CB , Hayes N , Bhatt A , Moore AR . J Womens Health (Larchmt) 2017 26 (3) 200-206 Widespread use of the human papillomavirus (HPV) vaccine has the potential to reduce incidence from HPV-associated cancers. However, vaccine uptake among adolescents remains well below the Healthy People 2020 targets. The Centers for Disease Control and Prevention (CDC) National Comprehensive Cancer Control Program (NCCCP) awardees are well positioned to work with immunization programs to increase vaccine uptake. The CDC chronic disease management information system was queried for objectives and activities associated with HPV vaccine that were reported by NCCCP awardees from 2013 to 2016 as part of program reporting requirements. A content analysis was conducted on the query results to categorize interventions according to strategies outlined in The Guide to Community Preventive Services and the 2014 President's Cancer Panel report. Sixty-two percent of NCCCP awardees had planned or implemented at least one activity since 2013 to address low HPV vaccination coverage in their jurisdictions. Most NCCCP awardees (86%) reported community education activities, while 65% reported activities associated with provider education. Systems-based strategies such as client reminders or provider assessment and feedback were each reported by less than 25% of NCCCP awardees. Many NCCCP awardees report planning or implementing activities to address low HPV vaccination coverage, often in conjunction with state immunization programs. NCCCP awardees can play a role in increasing HPV vaccination coverage through their cancer prevention and control expertise and access to partners in the healthcare community. |
"When I Needed It": Evaluation of the use and timing of Sharsheret's Thriving Again Program for young breast cancer survivors
Rohan EA , Townsend JS , Fleischmann A , Stahl S , Shoretz R . J Cancer Educ 2017 33 (5) 976-982 Approximately 11% of all new breast cancer cases in the USA occur in women aged 45 years or younger. In 2011, CDC funded seven organizations to develop or enhance programs for young breast cancer survivors (YBCS). This paper analyzed program evaluation data collected by one of these organizations to gain a more nuanced understanding of how recipients used the newly developed program and resources for YBCS. Sharsheret's Thriving Again program was evaluated through a web-based survey of survivorship program participants. The evaluation asked questions about participant demographics, use of the kit's survivorship care plan (SCP), satisfaction with the timing of survivorship kit receipt, and factors related to survivors' use of additional Sharsheret programs. We conducted bivariate analyses of survey responses and calculated chi-square statistics for significance testing. Of the 163 women who responded to the survey, 43% were diagnosed with breast cancer at or before age 45 and 69% were of Jewish descent. The majority of women who used the SCP found it helpful to facilitate cancer treatment (94%), follow-up (85%), or discussions with providers (91%). A total of 75% of women who received the SCP kit while either recently diagnosed or undergoing treatment were satisfied with the timing of receipt. Survey respondents found the Thriving Again program and survivorship kit beneficial and indicated timing preferences for when to receive resources and support. Supporting the self-efficacy of cancer survivors may improve survivors' quality of life and is an important aspect of survivorship programs. |
Prevalence of cancer screening among adults with disabilities, United States, 2013
Steele CB , Townsend JS , Courtney-Long EA , Young M . Prev Chronic Dis 2017 14 E09 INTRODUCTION: Many studies on cancer screening among adults with disabilities examined disability status only, which masks subgroup differences. We examined prevalence of receipt of cancer screening tests by disability status and type. METHODS: We used 2013 National Health Interview Survey data to assess prevalence of 1) guideline-concordant mammography, Papanicolaou (Pap) tests, and endoscopy and stool tests; 2) physicians' recommendations for these tests; and 3) barriers to health-care access among adults with and without disabilities (defined as difficulty with cognition, hearing, vision, or mobility). RESULTS: Reported Pap test use ranged from 66.1% (95% confidence interval [CI], 60.3%-71.4%) to 80.2% (95% CI, 72.4%-86.2%) among women with different types of disabilities compared with 81.4% (95% CI, 80.0%-82.7%) among women without disabilities. Prevalence of mammography among women with disabilities was also lower (range, 61.2% [95% CI, 50.5%-71.0%] to 67.5% [95% CI, 62.8%-71.9%]) compared with women without disabilities (72.8% [95% CI, 70.7%-74.9%]). Screening for colorectal cancer was 57.0% among persons without disabilities, and ranged from 48.6% (95% CI, 40.3%-57.0%) among those with vision limitations to 64.6% (95% CI, 58.5%-70.2%) among those with hearing limitations. Receiving recommendations for Pap tests and mammography increased all respondents' likelihood of receiving these tests. The most frequently reported barrier to accessing health care reported by adults with disabilities was difficulty scheduling an appointment. CONCLUSION: We observed disparities in receipt of cancer screening among adults with disabilities; however, disparities varied by disability type. Our findings may be used to refine interventions to close gaps in cancer screening among persons with disabilities. |
Adherence of primary care physicians to evidence-based recommendations to reduce ovarian cancer mortality
Stewart SL , Townsend JS , Puckett MC , Rim SH . J Womens Health (Larchmt) 2016 25 (3) 235-41 Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians' knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality. |
Worksite cancer prevention activities in the National Comprehensive Cancer Control Program
Nahmias Z , Townsend JS , Neri A , Stewart SL . J Community Health 2016 41 (4) 838-44 Workplaces are one setting for cancer control planners to reach adults at risk for cancer and other chronic diseases. However, the extent to which Centers for Disease Control and Prevention-funded National Comprehensive Cancer Control Programs (NCCCP) implement interventions in the workplace setting is not well characterized. We conducted a qualitative content analysis of program action plans submitted by NCCCP grantees from 2013 to 2015 to identify and describe cancer prevention objectives and interventions in the workplace setting. Nearly half of NCCCP action reports contained at least one cancer prevention objective or intervention in the workplace setting. Common interventions included education about secondhand smoke exposure in the workplace, and the importance of obtaining colorectal cancer screening. Workplace interventions were relatively common among NCCCP action plans, and serve as one way to address low percentages of CRC screening, and reduce risk for obesity- and tobacco-related cancers. |
Comprehensive cancer control partners' use of and attitudes about evidence-based practices
Steele CB , Rose JM , Townsend JS , Fonseka J , Richardson LC , Chovnick G . Prev Chronic Dis 2015 12 E113 INTRODUCTION: National Comprehensive Cancer Control Program (NCCCP) awardees are encouraged to work with partners (eg, nonprofit organizations) to develop and implement plans to reduce the cancer burden in their jurisdictions using evidence-based practices (EBPs). However, the extent of EBP use among awardees and their partners is not well understood. METHODS: From March through July 2012, we conducted a web-based survey of program partners referred by NCCCP program directors who were involved in implementation of cancer control plans. RESULTS: Approximately 53% of referred partners (n = 83) completed surveys, 91.6% of whom represented organizations. Most partners reported involvement in helping to identify (80.5%), adapt (81.7%), implement (90.4%), and evaluate (81.9%) EBPs. The factors rated most frequently as very important when selecting EBPs were "consistent with our organization's mission" (89.2%) and "cost-effective" (81.9%). Although most respondents said that their organizations understood the importance of using EBPs (84.3%) and had adequate access to cancer registry data (74.7%), few reported having sufficient financial resources to develop new EBPs (7.9%). The most frequently mentioned benefit of using EBPs was that they are proven to work. Resource limitations and difficulty adapting EBPs for specific populations and settings were challenges. CONCLUSIONS: Our findings help indicate how NCCCP partners are involved in using EBPs and can guide ongoing efforts to encourage the use of EBPs for cancer control. The challenges of using EBPs that partners identified highlight the need to improve strategies to translate cancer prevention and control research into practice in real-world settings and for diverse populations. |
Health behaviors and quality of life among colorectal cancer survivors
Rohan EA , Townsend JS , Fairley TL , Stewart SL . J Natl Compr Canc Netw 2015 13 (3) 297-302 PURPOSE: To examine, at the population level, health behaviors, comorbidities, and health-related quality of life among colorectal cancer (CRC) survivors compared with other cancer survivors and persons without cancer. METHODS: We used data from the 2009 and 2010 Behavioral Risk Factor Surveillance System cancer survivor modules. We calculated descriptive statistics, conducted chi-square tests for comparisons, and used multivariable logistic regression analysis to compare CRC survivors with other cancer survivors and persons without cancer. RESULTS: Of the 52,788 cancer survivors included in this analysis, 4001 reported being CRC survivors. When compared with other cancer survivors, CRC survivors reported higher percentages of obesity and lack of physical activity; however, they had lower levels of current smoking. Adjusted results show that CRC survivors were significantly more likely to report lack of physical activity, fair/poor health, and other chronic health conditions compared with persons without a cancer diagnosis. Conversely, CRC survivors reported lower levels of current smoking than persons without cancer. CONCLUSIONS: CRC survivors have a higher proportion of heath conditions and behaviors that may significantly increase their risks for recurrence or development of a second cancer. Targeted interventions to address these health issues should be considered. |
What does a performance measurement system tell us about the National Comprehensive Cancer Control Program?
Townsend JS , Moore AR , Mulder TN , Boyd M . J Public Health Manag Pract 2014 21 (5) 449-58 CONTEXT: The National Comprehensive Cancer Control Program (NCCCP) performance measurement system seeks to understand both the processes that funded programs undertake with their respective coalitions to implement the objectives of their cancer plans and the outcomes of those efforts. OBJECTIVE: To identify areas of achievement and technical assistance needs of NCCCP awardees. DESIGN:: Program performance was assessed through surveys completed by program directors on performance indicators in 2009 and 2010 and queries from a Web-based management information system in 2011 and 2012. SETTING: Programs funded by the Centers for Disease Control and Prevention's NCCCP. PARTICIPANTS: Sixty-nine programs. MAIN OUTCOME MEASURE(S): The key performance measures assessed were inclusion of diverse partners and key sectors in cancer coalitions, partners' involvement in activities, receiving in-kind resources from partners, using evidence-based interventions and data for setting priorities, conducting program evaluation, using community- or organization-level strategies to address cancer control efforts, and demonstrating progress toward achieving health outcomes. RESULTS: Most programs reported having active coalitions that represent diverse organizational sectors. Nearly all programs routinely assess the burden of cancer. In-kind resources to implement activities peaked at $64716 in the second year of a 5-year funding cycle and declined in subsequent project years. By year 3, more than 70% of programs reported having an evaluation plan. While programs reported that nearly two-thirds of their interventions were evidence-based, some programs implemented non-evidence-based interventions. A majority of programs successfully used at least 1 community- or organization-level change strategy. However, many programs did not incorporate objectives linked to health outcomes as they reported progress in implementing interventions. CONCLUSIONS: While NCCCP programs were strong at building and maintaining infrastructure, some programs may need additional technical assistance to increase the adoption of evidence-based interventions, develop solid and responsive evaluation plans, and better link efforts to population-based measures that demonstrate impact toward reducing the burden of cancer. |
Current cervical cancer screening knowledge, awareness, and practices among U.S. Affiliated Pacific Island providers: opportunities and challenges
Townsend JS , Stormo AR , Roland KB , Buenconsejo-Lum L , White S , Saraiya M . Oncologist 2014 19 (4) 383-93 BACKGROUND: Cervical cancer is a leading cause of cancer mortality in nearly all U.S. Affiliated Pacific Island Jurisdictions (USAPIJ); however, most jurisdictions are financially and geographically limited in their capacity to deliver routine screening. METHODS: We conducted a cross-sectional survey of 72 health care providers from five of the six USAPIJ in 2011 to assess knowledge, beliefs, practices, and perceived barriers regarding routine cervical cancer screening. We compared the responses of providers from jurisdictions that were funded by the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) with those that were not funded. RESULTS: Most providers reported cervical cancer prevention as a priority in their clinical practices (90.3%) and use the Papanicolaou test for screening (86.1%). Many providers reported knowledge of screening guidelines (76.4%); however, more than half reported that annual screening is most effective (56.9%). Providers in non-NBCCEDP-funded jurisdictions reported greater acceptance of visual inspection with acetic acid (93.9%) and self-sampling for human papillomavirus testing (48.5%) compared with NBCCEDP-funded jurisdictions (15.4% and 30.8% respectively). Providers from non-NBCCEDP-funded jurisdictions reported inadequate technological resources for screening women (42.4%), and approximately 25% of providers in both groups believed that screening was cost-prohibitive. CONCLUSION: Although cervical cancer screening is a priority in clinical practice, beliefs about annual screening, costs associated with screening, and varying levels of support for alternative screening tests pose barriers to providers throughout the USAPIJ. Further exploration of using evidence-based, lower cost, and sustainable screening technologies is warranted in addition to emphasizing timely follow-up of all positive cases. |
Use of evidence-based practices and resources among Comprehensive Cancer Control Programs
Steele CB , Rose JM , Chovnick G , Townsend JS , Stockmyer CK , Fonseka J , Richardson LC . J Public Health Manag Pract 2014 21 (5) 441-8 CONTEXT: While efforts to promote use of evidence-based practices (EBPs) for cancer control have increased, questions remain whether this will result in widespread adoption of EBPs (eg, Guide to Community Preventive Services interventions) by comprehensive cancer control (CCC) programs. OBJECTIVE: To examine use of EBPs among CCC programs to develop cancer control plans and select interventions. DESIGN: Conducted Web-based surveys of and telephone interviews with CCC program staff between March and July 2012. SETTING: CCC programs funded by the Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP). PARTICIPANTS: Sixty-one CCC program directors. MAIN OUTCOME MEASURES: 1) Use of and knowledge/attitudes about EBPs and related resources and 2) EBP-related technical assistance needs. RESULTS: Seventy-five percent of eligible program directors reported use of EBPs to a moderate or great extent to address program objectives. Benefits of using EBPS included their effectiveness has been proven, they are an efficient use of resources, and they lend credibility to an intervention. Challenges to using EBPs included resource limitations, lack of culturally appropriate interventions, and limited skills adapting EBPs for local use. Most respondents had heard of and used Web sites for The Guide to Community Preventive Services (95% and 91%, respectively) and Cancer Control P.L.A.N.E.T. (98% and 75%, respectively). Training needs included how to adapt an EBP and its materials for cultural appropriateness (state 78%, tribe 86%, territory 80%) and how to maintain the fidelity of an EBP (state 75%, tribe 86%, territory 60%). CONCLUSIONS: While awareness, knowledge, and use of EBPs and related resources are high, respondents identified numerous challenges and training needs. The findings from this study may be used to enhance technical assistance provided to NCCCP grantees related to selecting and implementing EBPs. |
Physician visits and preventive care among Asian American and Pacific Islander long-term survivors of colorectal cancer, USA, 1996-2006
Steele CB , Townsend JS , Tai E , Thomas CC . J Cancer Surviv 2013 8 (1) 70-9 PURPOSE: Published literature on receipt of preventive healthcare services among Asian American and Pacific Islander (API) cancer survivors is scarce. We describe patterns in receipt of preventive services among API long-term colorectal cancer (CRC) survivors. METHODS: Surveillance, Epidemiology, and End Results registry-Medicare data were used to identify 9,737 API and white patients who were diagnosed with CRC during 1996-2000 and who survived 5 or more years beyond their diagnoses. We examined receipt of vaccines, mammography (females), bone densitometry (females), and cholesterol screening among the survivors and how the physician specialties they visited for follow-up care correlated to services received. RESULTS: APIs were less likely than whites to receive mammography (52.0 vs. 69.3 %, respectively; P < 0.0001) but more likely to receive influenza vaccine, cholesterol screening, and bone densitometry. These findings remained significant in our multivariable model, except for receipt of bone densitometry. APIs visited PCPs only and both PCPs and oncologists more frequently than whites (P < 0.0001). Women who visited both PCPs and oncologists compared with PCPs only were more likely to receive mammography (odds ratio = 1.40; 95 % confidence interval, 1.05-1.86). CONCLUSIONS: Visits to both PCPs and oncologists were associated with increased use of mammography. Although API survivors visited these specialties more frequently than white survivors, API women may need culturally appropriate outreach to increase their use of this test. IMPLICATIONS FOR CANCER SURVIVORS: Long-term cancer survivors need to be aware of recommended preventive healthcare services, as well as who will manage their primary care and cancer surveillance follow-up. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 22, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure