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Background The COVID-19 pandemic involved business closures (e.g., gyms), social distancing policies, and prolonged stressful situations that may have impacted engagement in health behaviors. Our study assessed changes in cancer-related health behaviors during the pandemic, specifically physical activity, fruit/vegetable intake, smoking/tobacco use, and alcohol consumption. Methods Eight cancer centers administered mailed/web-based/telephone surveys between June 2020 and March 2021. Surveys assessed demographics, perceptions on social distancing, and self-reported changes of behaviors (less/same/more) associated with cancer prevention or risk, e.g., physical activity, fruit/vegetable intake, tobacco/smoking use, and alcohol consumption. Descriptive analyses and logistic regression models assessed association of variables with behavior change. Results Most of the 21,911 respondents reported adhering to at least 4(of 5) social distancing measures (72%) and indicated social distancing was very/somewhat important to prevent the spread of COVID-19 (91%). 35% of respondents reported less physical activity, 11% reported less fruit/vegetable intake, 27% reported more smoking/tobacco use (among those who used tobacco/smoking products in past 30 days), and 23% reported more alcohol consumption (among those who reported at least 1 drink in past 30 days) than before the pandemic. Urban residence, younger age, female gender, and worse general health were associated with less physical activity, less fruit/vegetable intake, more smoking/tobacco use, and more alcohol intake. Higher educational attainment was associated with less physical activity and fruit/vegetable intake and more alcohol consumption. Reporting social distancing as important and adhering to more COVID-19 safety practices were associated with less physical activity and more alcohol consumption. Conclusion Our findings suggest that certain demographics and those who adhered to social distancing measures were more likely to self-report unfavorable changes in health behaviors during the pandemic. Future studies should examine if the behaviors returned to baseline following relief from pandemic restrictions, and if these behavior changes are associated with increased cancer incidence and mortality.

Background Higher weight individuals report experiencing weight‐based stigma in the healthcare setting; within the cancer continuum, the most robust evidence exists for cancer screening. More research is needed to understand whether and how higher weight patients experience weight stigma during cancer treatment. Methods We conducted semi‐structured interviews with 15 breast and 15 cervical cancer survivors diagnosed 2017–2019 in Iowa who had a pre‐diagnosis body mass index of 30+ kg/m2 calculated from their driver's license height and weight. Interviews focused on whether individuals perceived being treated differently because of their weight in daily life, in healthcare, or during cancer treatment. Data were coded using a combination of inductive and deductive approaches, and analyzed using a multi‐phase thematic analysis. Results Almost all interviewees reported positive experiences during cancer treatment; several described their weight as never being an issue. Some identified weight stigma during cancer diagnosis or treatment that resulted in delayed diagnoses or changes in treatment. Many interviewees described situations where their weight was discussed negatively during cancer treatment, but most did not identify these as stigmatizing because their providers were only “concerned about [their] health.” Additional themes developed included experiencing environmental stigma, the discussion of cancer recurrence by providers only as it related to weight, and misconceptions of the causes and consequences of obesity. Conclusions While several participants did not feel that their weight impacted cancer treatment, some reported experiences of weight stigma pre‐diagnosis and during treatment. When individuals noted their weight was discussed during treatment, internalized bias may have impacted whether they considered these discussions stigmatizing.

Background The University of Kentucky Markey Cancer Center Affiliate Network (MCCAN) is a complex, multilevel evidence-based intervention (EBI) aimed at enhancing access to high-quality cancer services for under-served patients. MCCAN is promising but has not been scaled beyond its original context. We aimed to adapt MCCAN, originally developed in Kentucky, to address systematic differences that threatened its implementation and effectiveness in a new context, Iowa, yielding the Iowa Cancer Affiliate Network (I-CAN). Methods We report our adaptation of MCCAN using the Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI) approach: (1) identify key information about MCCAN, learning about Kentucky and Iowa contexts and users; (2) adapt MCCAN’s forms while leaving its core functions intact to produce I-CAN; and (3) evaluate I-CAN. Specifically, we conducted studies to identify MCCAN’s forms and core functions, gathered extensive knowledge of the original and new contexts, and identified systematic differences between the two. We created a matrix to map MCCAN’s core functions to its original forms, contextual differences between Kentucky and Iowa, and proposed adapted forms to produce I-CAN. We interviewed I-CAN affiliates to assess perceptions of acceptability, feasibility, and efficacy. Results MCCAN forms were mapped to eight intervention and 10 implementation core functions. Adaptation was required for 11 core functions, as contextual differences impacted the ability of the original forms of those core functions to be carried out in the new context. Contextual differences reflected existing relationships and referral patterns, as well as available resources (e.g., personnel and infrastructure). Lack of familiarity with the intervention process and outcomes limited the ability of I-CAN affiliates to evaluate potential adapted forms. Forms evolved as I-CAN affiliates gained practical experience in applying them and/or experienced changes in organizational structure, personnel, etc. Conclusions We successfully adapted MCCAN, a complex, multilevel EBI designed to support community hospitals and enhance access to high-quality cancer services and programs in Kentucky to improve care for patients in Iowa affected by cancer—nearly half of whom reside in rural areas. Our application of MODIFI suggests several opportunities for refinement to advance successful EBI adaptation. Trial registration ClinicalTrials.gov, NCT05645328. Registered 01 December 2022, https://clinicaltrials.gov/study/NCT05645328

Purpose Evidence of the impact of the COVID‐19 pandemic on cancer prevention and control is growing, but little is known about patient‐level factors associated with delayed care. We analyzed data from a survey focused on Iowan cancer patients' COVID‐19 experiences in the early part of the pandemic. Methods Participants were recruited from the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden (PERCH) program. We surveyed respondents on demographic characteristics, COVID‐19 experiences and reactions, and delays in any cancer‐related health care appointment, or cancer‐related treatment appointments. Two‐sided significance tests assessed differences in COVID‐19 experiences and reactions between those who experienced delays and those who did not. Results There were 780 respondents (26% response), with breast, prostate, kidney, skin, and colorectal cancers representing the majority of respondents. Delays in cancer care were reported by 29% of respondents. In multivariable‐adjusted models, rural residents (OR 1.47; 95% CI 1.03, 2.11) and those experiencing feelings of isolation (OR 2.18; 95% CI 1.37, 3.47) were more likely to report any delay, where experiencing financial difficulties predicted delays in treatment appointments (OR 5.72; 95% CI 1.96, 16.67). Health insurance coverage and concern about the pandemic were not statistically significantly associated with delays. Conclusion These findings may inform cancer care delivery during periods of instability when treatment may be disrupted by informing clinicians about concerns that patients have during the treatment process. Future research should assess whether delays in cancer care impact long‐term cancer outcomes and whether delays exacerbate existing disparities in cancer outcomes. This manuscript assesses impacts of the COVID‐19 pandemic on cancer‐related medical care among cancer patients receiving care at an academic medical center. We report delays for any cancer care and by treatment type mid‐pandemic and differences between those who experienced delays in care and those who did not in perceptions of social distancing measures, use of social distancing measures, and pandemic‐related concern.

BackgroundRural cancer patients receive lower-quality care and experience worse outcomes than urban patients. Commission on Cancer (CoC) accreditation requires hospitals to monitor performance on evidence-based quality measures, but the impact of accreditation is not clear due to lack of data from non-accredited facilities and confounding between patient rurality and hospital accreditation, rurality, and size.MethodsThis retrospective, observational study assessed associations between rurality, accreditation, size, and performance rates for four CoC quality measures (breast radiation, breast chemotherapy, colon chemotherapy, colon nodal yield). Iowa Cancer Registry data were queried to identify all eligible patients diagnosed between 2011 and 2017. Cases were assigned to the surgery hospital to calculate performance rates. Univariate and multivariate regression models were fitted to identify patient- and hospital-level predictors and assess trends.ResultsThe study cohort included 10,381 patients; 46% were rural. Compared with urban patients, rural patients more often received treatment at small, rural, and non-accredited facilities (p < 0.001 for all). Rural hospitals had fewer beds and were far less likely to be CoC-accredited than urban hospitals (p < 0.001 for all). On multivariate analysis, CoC accreditation was the strongest, independent predictor of higher hospital performance for all quality measures evaluated (p < 0.05 in each model). Performance rates significantly improved over time only for the colon nodal yield quality measure, and only in urban hospitals.ConclusionsCoC accreditation requires monitoring and evaluating performance on quality measures, which likely contributes to better performance on these measures. Efforts to support rural hospital accreditation may improve existing disparities in rural cancer treatment and outcomes.

Rectal cancer guidelines recommend transrectal ultrasound or magnetic resonance imaging for locoregional staging and neoadjuvant chemoradiation therapy (CRT) for Stage II/III disease, but studies show these are underutilized. We examined how surgeon preferences align with guidelines or vary by training. Questionnaires on training, years of practice, and staging/treatment preferences were sent to surgeons practicing in Florida. Of 759 surveys distributed, 321 (42%) responded; 158 were excluded because they were trainees, not treating rectal cancer, or not board certified/eligible. Among the remaining 163, 71% were general surgeons, 18% colorectal surgeons, and 11% surgical oncologists. Colorectal surgeons and surgical oncologists were more likely than general surgeons to prefer transrectal ultrasound/magnetic resonance imaging (79% vs 50%; P < .01), and neoadjuvant CRT (71% vs 45%; P < .01). Differences remained significant after adjusting for years in practice. Increased focus on appropriate use of staging procedures and neoadjuvant CRT within general surgery training/educational programs is warranted.

BackgroundCancer patients treated in community hospitals receive less guideline-recommended care and experience poorer outcomes than those treated in academic medical centers or National Cancer Institute-Designated Cancer Centers. The Markey Cancer Center Affiliate Network (MCCAN) was designed to address this issue in Kentucky, the state with the highest cancer incidence and mortality rates in the U.S.MethodsUsing data obtained from the Kentucky Cancer Registry, the study evaluated the impact of patients treated in MCCAN hospitals on four evidence-based Commission on Cancer (CoC) quality measures using a before-and-after matched-cohort study design. Each group included 13 hospitals matched for bed size, cancer patient volume, community population, and region (Appalachian vs. non-Appalachian). Compliance with quality measures was assessed for the 3 years before the hospital joined MCCAN (T1) and the 3 years afterward (T2).ResultsIn T1, the control hospitals demonstrated greater compliance with two quality measures than the MCCAN hospitals. In T2, the MCCAN hospitals achieved greater compliance in three measures than the control hospitals. From T1 to T2, the MCCAN hospitals significantly increased compliance on three measures (vs. 1 measure for the control hospitals). Although most of the hospitals were not accredited by the CoC in T1, 92% of the MCCAN hospitals had achieved accreditation by the end of T2 compared with 23% of the control hospitals.ConclusionAfter the MCCAN hospitals joined the Network, their compliance with quality measures and achievement of CoC accreditation increased significantly compared with the control hospitals. The unique academic/community-collaboration model provided by MCCAN was able to make a significant impact on improvement of cancer care. Future research is needed to adapt and evaluate similar interventions in other states and regions.

The COVID-19 pandemic has prevented many adolescents from receiving their vaccines, including the human papillomavirus (HPV) vaccine, on time. However, little is known about the impact of the pandemic on implementation of clinic-level evidence-based interventions (EBIs) that help to improve HPV vaccine uptake. In this qualitative study, we explored the pandemic's impact on EBI implementation and HPV vaccine delivery. During August-November 2020, we interviewed clinic managers in a rural, midwestern state about their experiences implementing EBIs for HPV vaccination during the COVID-19 pandemic. We used a multipronged sampling approach with both stratified and purposive sampling to recruit participants from Vaccines for Children clinics. We then conducted a thematic analysis of transcripts. In interviews (N = 18), 2 primary themes emerged: decreased opportunities for HPV vaccination and disruption to HPV-related implementation work. Most participants reported decreases in opportunities to vaccinate caused by structural changes in how they delivered care (eg, switched to telehealth visits) and patient fear of exposure to COVID-19. Disruptions to EBI implementation were primarily due to logistical challenges (eg, decreases in staffing) and shifting priorities. During the pandemic, clinics struggled to provide routine care, and as a result, many adolescents missed HPV vaccinations. To ensure these adolescents do not fall behind on this vaccine series, providers and researchers will need to recommit to EBI implementation and use existing strategies to promote vaccination. In the long term, improvements are needed to make EBI implementation more resilient to ensure that progress does not come to a halt in future pandemic events.

Purpose Recent advances in head and neck cancer (HNC) treatment, such as increased use of organ-preserving advanced radiation treatments, the approval of cetuximab for HNC treatment, and the increase in human papillomavirus (HPV)-related HNC, have changed clinical approaches to HNC management. We sought to identify treatment trends in a population-based cohort of HNC patients. Methods The Surveillance, Epidemiology, and End Results Patterns of Care program collected additional treatment and HPV testing information on stratified random samples of HNC patients diagnosed in 1997 ( n  = 473), 2004 ( n  = 1,317), and 2009 ( n  = 1,128). Rao–Scott Chi-square tests were used to examine unadjusted associations between year of diagnosis and patient sociodemographic, tumor, and treatment characteristics. Cochran–Armitage tests for trend were used to examine the hypothesis that certain treatments were used increasingly (or decreasingly) over the time period, while logistic regression was used to examine factors associated with particular treatments. Results Use of radiation and chemotherapy without surgery significantly increased for all HNC sites between 1997 and 2009. Cetuximab and taxane use also showed a significantly increasing trend. Lack of insurance was associated with not receiving treatment in multivariate models. The majority (64%) of cases undergoing radiation in 2009 received an advanced treatment, with 55% receiving intensity modulated. The majority of oropharyngeal cases with known HPV status received chemotherapy and radiation only (62%) and nearly all were insured and had one or fewer comorbidities. Conclusions Treatment patterns have changed for HNC, leading to increased incorporation of systemic therapy and newer radiation techniques. HPV testing should be targeted for more widespread use, especially in traditionally underserved groups.