bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract A26: Caseload for patient navigation: What is keeping navigators busy?
Authors: Howard Mary Beth , Freund Karen , Battaglia Tracy 
Published: December 2010

Abstract
Patient navigation is an innovative type of care management designed to reduce cancer disparities. As many sites adopt this model of care, a frequent query is how to assess appropriate caseload for these new positions. While data on the effectiveness of patient navigation interventions appears promising, there is a lack of methods to assess appropriate caseload for optimal effect of navigator intervention. Boston University and its affiliated Community Health Centers (CHCs) is one of nine sites participating in the NCI CRCHD National Cancer Institute Patient Navigation Research Program (PNRP), which aims to evaluate whether navigation improves cancer outcomes.
The purpose of this study is to develop and describe the caseload across six CHCs participating in the Boston PNRP. Navigators target female patients with abnormal breast or cervical cancer screening. Review of the literature identified several concepts to consider in assessing caseload. We examined the following four factors at each navigation site: (1) absolute number of cases navigated, (2) total patient days in navigation, (3) total time spent navigating, and (4) total documented patient-navigator encounters.
Eligible participants were women over 18 with an abnormal mammogram or Pap test at the participating CHCs from 7/1/2007 through 6/31/2008. Patients were navigated until their screening abnormality was resolved with a definitive diagnosis (cancer or noncancer) or until the end of cancer treatment.
Across the six CHCs, the median number of patients navigated was 145 (range: 19-216). The median number of encounters per patient at each of the CHCs was 5 (range: 3-11). The median time spent navigating per patient was 135 minutes (range: 77-240). The median number of days in navigation per patient was 56 (range: 73-142). The number of active patients a navigator was tracking, on average, ranged from 7 to 53 patients per day (median: 38).
We conclude that measuring caseload is more complex than counting heads. The four descriptions of caseload provide different representations of navigator workload that vary among the six CHCs. Patient characteristics (age, race/ethnicity, language, insurance) were not associated with these measures of caseload. Due to the different constructs assessed in each measure, a single caseload score may not adequately reflect navigator workload. Next research steps will involve assessing the predictive ability of these constructs on outcomes to help determine an appropriate navigator caseload.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A26.
Abstract A3: Design and model for breast cancer literacy outcomes among medically underserved females in Michigan
Authors: Todem David , Williams Karen Patricia 
Published: December 2010

Abstract
Statistical theory requires that analysis of study outcomes be conducted conditional on the design process. Ignoring this process may result in severely biased estimates, leading to false inferences, especially when the outcome variable is associated with design variables. We propose in this paper a class of hierarchical models to investigate the dependence between the design process and the study outcomes of primary interest. We discuss a fully parametric and a semiparametric formulation of the hypothesized model and propose the EM algorithm to obtain maximum likelihood estimates. Our numerical results show that the semiparametric approach outperforms the fully parametric model with respect to some key features of the model. The methodology is used to gain insight into the mechanism that generates breast cancer literacy outcomes in a study conducted among medically underserved females in Michigan.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A3.
Abstract A31: Patient navigation for culturally diverse populations: The experience of the Moffitt Cancer Center's Patient Navigator Research Program (PNRP)
Authors: Wells Kristen J. , Calcano Ercilia R. , Meade Cathy D. , Roetzheim Richard G. , Roetzheim G. , Estampador Angela , Arevalo-Mez Lillean , Espejo Luis , Abdulla Rania , Sarmiento Yolanda , Ross-Inda Nikki , Sanchez Diana , Gonzalez Lisa , Reyes-Garcia Aileen , Rivera Marlene 
Published: December 2010

Abstract
The purpose of the PNRP patient navigation is to provide individualized assistance to persons with abnormal cancer screening tests or cancer diagnosis by trained, culturally sensitive navigators familiar with the patient's community. The Moffitt Cancer Center is one of nine NCI-funded sites nationally to study the impact that patient navigation has on four main outcomes: 1) time from screening to definitive diagnosis; 2) time from definitive diagnosis to treatment; 3) patient satisfaction; and 4) cost effectiveness. Moffitt's patient navigators navigated over 640 patients referred from seven community clinics in four counties. The majority of the patients were female (93%), Hispanics (54%), with annual household income under $20,000 (80%), mostly unemployed (47.5%), and with an average of 8.8 years of education. Lay patient navigators familiar with the patients’ culture and language were trained to navigate patients with breast or colorectal cancer screening abnormalities. The navigators were asked to record in a log the barriers that they identified, along with the actions they took to assist the patients address such barriers. Navigators addressed 20 different types of barriers in an average of 10 encounters per patient. This presentation will 1) describe the processes of patient navigation utilized by Moffitt PNRP, including training requirements, and caseloads for patient navigators, and 2) discuss the most relevant barriers that navigators found among medically underserved patients to access cancer health services, and actions taken to address such barriers. Moffitt patient navigators engage in a number of actions to help address unique barriers faced by this population when trying to access cancer care services.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A31.
Abstract A33: Culturally relevant cancer risk counseling for underserved Latinas
Authors: Gloria Juarez , Perez Martin , Lagos Veronica , Blazer Katheleen , Ogaz Raquel , Weitzel Jeffrey 
Published: December 2010

Abstract
Background: Latinas are as likely as the majority to have high cancer risk associated with genetic predisposition to breast cancer and ovarian cancer. Disproportionately underserved, Latinas have a compelling need for access to genetic cancer risk assessment (GCRA) and cancer screening and prevention measures.
Objectives: The primary purpose of this project was to evaluate the effects of a culturally relevant GCRA intervention for Latinas.
Methods: Four focus groups were conducted consisting of Latinas that have undergone GCRA. Participants completed a demographic questionnaire that included items assessing perceived cancer risk and satisfaction with GCRA. The focus groups entailed a facilitated discussion of the key study variables and other culturally relevant issues that may impact the GCRA intervention. Descriptive statistics and thematic analysis were used.
Results: Perceived sense of lack of information and uncertainty about what to expect appeared to play a key role in distress. Most women initially had negative expectations (expecting the worse or bad outcome), but ultimately felt hopeful that they could learn more about the GCRA process and what it meant for them. Information was cited as the primary contributor to positive psychosocial outcomes specifically increased locus of control and self-efficacy. The major cultural themes identified were destiny, religious and spiritual coping, how cultural attitudes and belief influence lack of information, community awareness, and public health issues.
Conclusions: Findings indicate that the pre-GCRA window may be most distressing for this population indicating that this may be the most appropriate time for psychological intervention.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A33.
Abstract A34: Short-term evaluation of telephone-based genetic counseling for hereditary breast and ovarian cancer among African American women: A pilot study
Authors: Vadaparampil Susan T. , Pal Tuya 
Published: December 2010

Abstract
Introduction: Genetic counseling (GC) services for inherited breast and ovarian cancer (HBOC) are underutilized by African American (AA) women. One barrier may be availability of in-person GC services. Telephone-based counseling may be one way to increase access to GC services. However, little is known about AA women's reactions to and satisfaction with phone-based GC services. We sought to evaluate experiences associated with phone-based GC for HBOC among AA women diagnosed with early-onset breast cancer.
Methods: Through a cancer registry-based study, phone-based GC for HBOC was provided to AA women diagnosed with breast cancer at or before age 50. A brief baseline survey to evaluate the experience with the GC and testing process was administered when women were being scheduled to receive results of BRCA testing. After phone-based results disclosure with a genetic counselor, a follow-up phone survey was administered to assess results disclosure experiences.
Results: To date, baseline and follow-up surveys have been completed by 33 (72%) of 46 women who completed pre-test GC. Findings from the baseline questionnaire (n=36) showed that the majority of women were glad to have pursued testing (95%), felt that they had taken charge of their healthcare (90%), and were pleased with the telephone GC provided through the study (71 %). Almost 40% of participants indicated that the GC and testing process increased their feelings of control and empowerment. Among the follow-up survey participants (n=33), the majority indicated very positive experiences with various aspects of phone-based results disclosure.
Conclusion: Our results suggest that telephone-based GC and testing for HBOC in a registry-based sample of AA women was perceived favorably by participants. Thus, telephone-based GC may be one approach to reduce barriers in access to GC and testing services in the AA community.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A34.
Abstract A48: Class, culture, and patterns of cancer care navigation
Authors: Gage Elizabeth A. 
Published: December 2010

Abstract
Background: While previous research has established a link between socioeconomic status (SES) and cancer outcomes, there is still little understanding of the processes that contribute to these outcome disparities. The mechanisms though which individuals actually translate SES-related resources into health advantage remain imperfectly understood. The systematically different patterns of health care navigation that patients enact are one pathway in which SES has been hypothesized to impact health outcomes. Building upon research documenting the ways that social class and culture impacts family life, this research examines the adaptive strategies families use after a child has been diagnosed with cancer. It extends Fundamental Cause Theory (Link and Phelan 1995) and Cultural Health Capital (Shim 2010) which have become prominent theories for understanding the role of class in health disparities.
Methods: This research combines in-depth interviews with 55 parents of pediatric cancer patients with ethnographic case studies of five families to document how SES influences patterns of navigating the health care community after a serious medical diagnosis.
Results: Findings indicate that the high SES warrior advocate parents view themselves as collaborative members of the health care team, and peers with physicians. These parents conduct sophisticated medical research, seek second opinions, and actively network within the health care community. Low SES parents enact a survivor style where they maintain boundaries between patient and provider roles. They view physicians as authority figures, trust clinicians to guide their health care and express frustrations communicating with health care professionals.
Conclusions: A more complete understanding of SES-based patterns of communication in heath settings enhances our understanding of the mechanisms underlying socioeconomic health disparities, and will help guide intervention initiatives aimed at reducing disparate outcomes for cancer patients.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A48.
Abstract A54: miRNA profiling: prognostic markers in chemoprevention
Authors: Williams Jennie L. , Ji Ping 
Published: December 2010

Abstract
Epidemiological data has demonstrated that colon cancer is disproportional in incidence and mortality between Caucasians and African Americans (AA). Whereas socioeconomic and dietary differences contribute to this disparity other underlying factors must be involved. For instance, the response to chemopreventive agents is different between these two populations. Since chemopreventive agents exert their effect through a molecular target, this disparity would suggest differences at the genetic level. Therefore, the generation and evaluation of chemopreventive agents that address the issue of chemoresistance is essential. As such, we have demonstrated that promising colon cancer chemopreventive agents, derivatives of nonsteroidal anti-inflammatory drugs (NSAIDs), inhibits colon cancer cell growth by inhibiting cell proliferation and enhancing cell killing. However, very little is known about the molecular targets in the cancer cell that are responsible for this effect. microRNAs (miRNAs), small (17-22 nt) regulatory RNAs, are known to control gene expression and translational repression or degradation, via specific sites at the 3’-UTR of its target mRNAs. The deletion or mutation of one particular miRNA could potentially lead to the progression of disease; specifically, cancer. Therefore, using total RNA isolated from tumors of xenographic mouse and colorectal cancer cells treated with NSAID derivatives, miRNA distribution patterns were determined. Protein lysates of the tumors and tissue culture cells were also examined for levels of transcriptional activating factors (i.e., NF-kB and p53). We demonstrate that derivatives of NSAIDs altered the synthesis or activity of multiple miRNA and transcriptional DNA-binding factors In vivo and In vitro. Of interest, our chemopreventive agents induced expression Levels of, among others, the tumor suppressor Let-7 miRNA family. In addition, this increase was directly related to the presence of a functional p53 gene product. Thus, a correlation of altered level of miRNA and the expression and/or activation of its target genes may assist us with ascertaining the association of miRNAs with poor clinical outcome.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A54.
Abstract A61: Prevalence of memory problems that limit daily functioning in a national representative sample of adult cancer patients in the United States population
Authors: i Michael Anton , Jean-Pierre Pascal , Armstrong Daniel , Lipschultz Steven , Miller Tracie L. 
Published: December 2010

Abstract
Background: Cancer and its treatments can impair many aspects of cognitive functioning, especially memory. Few epidemiological studies, however, have examined the prevalence of memory impairment in cancer patients and survivors. We determined the prevalence of memory problems in cancer and non-cancer populations.
Methods: We analyzed data from a stratified, multistage probability sample of the civilian, noninstitutionalized United States population drawn from the National Health and Nutrition Examination Survey. Participants answered yes or no to the question, “Are you limited in any way because of difficulty remembering or because you experience periods of confusion?” We adjusted our logit model for age, sex, race-ethnicity, education, poverty, and general health.
Results: The sample included 9,819 individuals (4,862 men; 4,957 women) age 40 years and older from diverse educational and racial-ethnic backgrounds (blacks [1,938], whites [5,552], Hispanics [1,998] and other race/multi-racial [331]). Of the total sample, 1,305 had cancer and 8,514 had not. Memory problems were reported more often by participants who had cancer (14%) than by those who did not (8%). Having had cancer was independently associated with memory impairment (odds ratio = 1.5[95% CI = 1.1 to 1.9]). Other predictors of memory impairment included older age, sex, race-ethnicity, lower education, higher poverty, and poor general health (P &lt; 0.01). Overall, participants with cancer had a 40% greater likelihood of having memory problems that interfered with daily functioning. Conclusions: Cancer history is an independent predictor of memory impairment. Strategies to assess and control this memory impairment for cancer patients and survivors are needed.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A61.
Abstract A79: Vitamin D status and breast cancer aggressiveness among African American and European American women in South Carolina
Authors: Steck Susan E. , Rosling Rebecca , Murphy E. Angela , Davis J. Mark , Hebert James R. 
Published: December 2010

Abstract
Background and Significance: Racial disparities exist in breast cancer, with African-American (AA) women being diagnosed with more aggressive disease and exhibiting higher mortality than their European-American (EA) counterparts. Vitamin D is of interest in breast cancer prevention and prognosis because of its ability to inhibit cell proliferation and induce apoptosis and differentiation in both normal and malignant breast cells. Circulating 25hydroxyD [25(OH)D] concentrations in humans are a measure of vitamin D status, and vary based on sun exposure, dietary intake, supplement use, skin tone, age, and body mass index [BMI = weight(kg)/height(m)2], among other factors. This study examines racial differences in vitamin D status and the association between serum 25(OH)D and clinical parameters among women diagnosed with breast cancer in South Carolina.
Methods: A total of 107 women between 33 and 84 years of age and diagnosed with breast cancer in the previous five years were enrolled in the study (n=60 AA, n=47 EA). Each participant donated a blood sample, and serum 25(OH)D was measured by enzyme immunoassay. Age, BMI, clinical characteristics, and treatment were abstracted from medical records.
Results: The mean (±SD) concentration of serum 25(OH)D in EA women was 29.8 ± 12.1 ng/ml while the mean concentration in AA women was 19.3 ± 10.0 ng/ml. Vitamin D deficiency (defined as serum 25(OH)D &lt;20ng/ml) was much more common among AAs (60%) compared with EAs (15%). Serum 25(OH)D concentrations decreased with increasing stage of disease and were lowest among women who were triple (ER/PR/HER2) negative compared with other groups. Women who were vitamin D deficient were 8 times more likely to be diagnosed with aggressive disease (defined as regional or distant stage) as compared to women who were sufficient in vitamin D, though the confidence interval was wide, indicating imprecision of the result (OR=8.6,95%CI=1.8,41.2, after adjustment for age, race, BMI, season and months since diagnosis).
Conclusions: This study corroborates other research showing racial differences in vitamin D status and provides further support for a protective role of vitamin D in breast cancer, particularly for highly aggressive disease. The prevalence of vitamin D deficiency and insufficiency was high, suggesting the need for monitoring of vitamin D levels among breast cancer patients.
This work was supported by grants from the National Cancer Institute, Center to Reduce Cancer Health Disparities (Community Networks Program) to the South Carolina Cancer Disparities Community Network (SCCDCN) [1 U01 CA114601] and the Cancer Center of the University of South Carolina.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A79.
Abstract A80: Physical activity reduces breast cancer risk in African American women
Authors: Sheppard Vanessa , Makambi Kepher , Wallington Sherrie , Sween Jennifer , Adams-Campbell Lucile , Taylor Teletia 
Published: December 2010

Abstract
Background: The reported inverse relationship between physical activity and breast cancer risk is under constant scrutiny, and the evidence is inconsistent. Furthermore, few studies have been conducted with African Americans.
Methods: A population-based case-control study identified 97 cases and 102 controls from the Washington, DC, area. A self-report physical activity questionnaire elicited responses on walking for exercise and vigorous physical activity (e.g., running, aerobics, etc.) in the past year. Responses were used to calculate a metabolic equivalent (MET) score [MET-hours/week= hours/week vigorous activityx7+ hours/week walking x3]. The MET score was categorized into low, medium and high tertiles. Multivariate logistic regression examined the association between physical activity and breast cancer.
Results: African American women who engaged in vigorous physical activity (&gt; 2 hours/week in the past year) had a 64% reduced risk of breast cancer compared to those who did not participate in any vigorous activity (odds ratio, OR = 0.36; 95% confidence interval, CI = 0.17-0.75). We also found a 64% reduced breast cancer risk in women with a high versus low tertile of total activity (OR = 0.36; 95% CI = 0.16-0.79). For postmenopausal women, vigorous physical activity and total activity (high versus low tertile) also had an inverse relationship with breast cancer (p&lt;.05).
Conclusion: Modest levels of physical activity can reduce breast cancer risk in African American women.
Impact: Targeted efforts to encourage more African American women to engage in modest levels of physical activity may positively impact disparate breast outcomes in this group.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A80.