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1. A Framework to Promote Implementation of Patient-Reported Outcomes in Institutions Caring for Vulnerable and Underserved Cancer Populations

Author

Schuster, Anne L. R., Crossnohere, Norah L., Boakye, Eric Adjei, Angove, Rebekah, Baldwin, Billie, Barreto, Esteban A., Chen, Ronald C., Gillespie, Theresa W., Hamilton, Betty, McCleary, Nadine Jackson, Karmo, Maimah, Kaufmann, Tara, Lee, William, Mehta, Vikas, Meyer, Larissa, Mittal, Kriti, Owens, Leah, Peterson, Rachel, Pusic, Andrea, Rainey, Anne Marie, Richardson, Angelique, Shapiro, Lauren, Sibbitt, Bethany, Smith, Cardinale, Vargo, Mary, Vickers, Andrew, Brundage, Michael, and Snyder, Claire

Published
2024
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14. Adverse Childhood Events Significantly Impact Depression and Mental Distress in Adults with a History of Cancer.

Author

Babatunde, Oluwole A., Gonzalez, Katherine, Osazuwa-Peters, Nosayaba, Adams, Swann Arp, Hughes Halbert, Chanita, Clark, Frank, Nagar, Anusuiya, Obeysekare, Jessica, and Adjei Boakye, Eric

Abstract

Simple Summary: This research was inspired by a desire to understand how adverse childhood experiences (ACEs) impact depression among cancer survivors. The study's findings revealed that cancer survivors with three or more ACEs had a depression rate of 40.8%, compared to 18.7% among those with one to two ACEs and 10.9% among those with no ACEs. Survivors with three or more ACEs were significantly more likely to report experiencing depression. Among the three ACE subtypes—sexual abuse, physical abuse, and having family members with mental illnesses—cancer survivors with family members suffering from mental illnesses had the highest odds of depression, followed by those who experienced physical abuse. These findings provide a crucial basis for health providers to screen cancer survivors for ACEs and depression, guiding proactive screening and treatment of depression in this vulnerable population. Objectives: Adverse childhood experiences (ACEs) are linked to a heightened risk of depression. We explored the relationship between ACEs and both depression and mental distress among cancer survivors. Methods: This was a cross-sectional analysis using the 2022 Behavioral Risk Factor Surveillance System database of cancer survivors aged ≥18 (n = 14,132). The primary outcome was self-reported history of depression, and the secondary outcome was mental distress. The exposure variable was the number of ACEs, classified as 0, 1–2, and ≥3. Weighted multivariable logistic regression models assessed the association between the number of ACEs and depression and mental distress while adjusting for covariates. Results: Approximately 22% of respondents reported experiencing ≥3 ACEs. The prevalence of depression was 21.8%, and mental distress was 15.4%. Compared with cancer survivors who had experienced 0 ACEs, those who had experienced ≥3 (aOR = 3.94; 95% CI, 3.04–5.10) or 1–2 (aOR = 1.85; 95% CI, 1.47–2.32) ACEs had a higher likelihood of reporting depression. Compared with cancer survivors who had experienced 0 ACEs, those who had experienced ≥3 (aOR = 0.67; 95% CI, 0.48–0.93) had a lower likelihood of reporting mental distress. Conclusions: This study highlights the impact of ACEs on depression in adulthood among cancer survivors. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Thresholds in PROMIS Scores Anchored to Subsequent Unscheduled Health Service Use Among People Diagnosed With Cancer.

Author

Sikorskii, Alla, Tam, Samantha, Given, Barbara, Given, Charles W., Adjei Boakye, Eric, Zatirka, Theresa, Nair, Mrudula, Su, Wan-Ting K., Jogunoori, Smitha, Watson, Peter, Movsas, Benjamin, and Chang, Steven

Subjects
TUMOR diagnosis, RESEARCH funding, MEDICAL care, OUTPATIENT medical care, FUNCTIONAL status, HOSPITAL emergency services, CANCER patients, RETROSPECTIVE studies, SYMPTOMS, DESCRIPTIVE statistics, CANCER pain, ODDS ratio, MEDICAL appointments, HEALTH outcome assessment, TUMORS, CANCER fatigue, SOCIODEMOGRAPHIC factors, CONFIDENCE intervals, DATA analysis software, MENTAL depression, COMORBIDITY
Abstract

PURPOSE: To establish thresholds in the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference, physical function, fatigue, and depression scores on the basis of their association with subsequent use of the emergency department (ED) or urgent care by people diagnosed with cancer. METHODS: Retrospective data from 952 people seen at Henry Ford Cancer and insured through the Health Alliance Plan were analyzed using generalized linear mixed-effects models. The log odds of ED or urgent care use during 14 or 30 days after each patient-reported outcome (PRO) assessment were related to PRO scores, while adjusting for comorbidity, sociodemographic, and tumor characteristics. RESULTS: Pain interference and physical function were associated with subsequent ED or urgent care visits, but fatigue and depression were not, and the results for 14- and 30-day visits were similar. Thresholds anchored in the likelihood of these visits differed according to cancer stage. For people with advanced cancer, a pain interference score of 60 or higher (odds ratio [OR] 3.75, [95% CI, 1.53 to 7.87]) and a physical function score lower than 40 (OR 2.94, [95% CI, 1.22 to 7.06]) produced the largest ORs with narrowest CIs for 30-day visits. For people with nonadvanced cancer, the thresholds of 65 for pain interference (OR 2.64, [95% CI, 1.40 to 5.01]) and 35 for physical function (OR 1.87, [95% CI, 1.01 to 3.45]) produced largest ORs with narrowest CIs for 30-day visits. CONCLUSION: These anchor-based thresholds in PROMIS scores can inform clinicians' actions with the goal of preventing ED or urgent care visits. PROMIS pain interference and physical function were related to emergency room or urgent care use. [ABSTRACT FROM AUTHOR]

Published
2024
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50. Racial/ethnic Disparities in Symptom Burden for Cancer Survivors on Immune Checkpoint Inhibitors

Author

Boakye, Eric Adjei

Abstract

The use of immune checkpoint inhibitors (ICIs), alone or in-combination with other cancer treatments, is increasing dramatically and with success in different cancer types. Despite the important clinical benefits of ICIs, its initiation is often delayed among minority cancer survivors and is associated with significant immune-related adverse events (irAEs), which can affect any organ or system of the body. While concerns about disparities in access to trials of new cancer drugs have been documented, whether these disparities extend to the patients receiving ICIs in real-world practice is limited. Time to initiation of ICIs and symptom burden outcomes are greatly understudied and overlooked in minority populations. The limited research available reported that a higher percentage of minority populations experienced delayed ICIs treatment initiation, and the prevalence and severity of symptoms burden (e.g., fatigue, pain, depression, anxiety, disturbed sleep) among cancer survivors are higher in minority populations. In addition, identifying survivors at an increased risk for irAEs helps to inform clinical decision-making about the management of irAEs and ICI treatment, however, little is known from the clinician’s perspective on the usefulness of survivor reports of adverse events. In this proposed project, we will address these critical public health concerns. First, we will examine racial and ethnic differences in time to initiation of ICI treatment, and we will evaluate if there are racial and ethnic differences in patient-reported irAEs after initiation of ICI treatment. Second, we will assess implementation outcomes at the clinician level (physicians, nurses, social workers, and psycho-oncologists) regarding the patient symptom summary reports. Specifically, we will examine a) feasibility as reflected by clinicians’ time to address symptom reports they receive, b) clinicians’ perceptions of acceptability and appropriateness of the symptoms summary reports they receive and c) clinicians’ actions on symptom reports (ICI treatment alterations, prescriptions of supportive care medications, referrals to supportive care services). Findings from this project will highlight possible racial/ethnic disparities, providing the basis for further investigation into ways of addressing these disparities. The project's focus on identifying disparities supports the Healthy People 2020 goals of eliminating health disparities and improving the quality of life of cancer survivors.

Published
2023
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