The overall 5‐year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence‐based, cancer‐specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer‐specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta‐analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health‐related behaviors and comorbidities, long‐term sequelae and patient‐reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.3322/caac.21719

American Cancer Society nutrition and physical activity guideline for cancer survivors

BackgroundDespite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity an...

https://journals.sagepub.com/doi/pdf/10.1177/26334895211049482

Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity:

Access to primary care was hindered by the coronavirus disease 2019 (COVID-19) pandemic. Evaluate changes in health screening rates before and during the pandemic. Retrospective analysis of health maintenance and disease management screening rates among primary care patients before and during the pandemic. Over 150,000 patients of a large, academic health system. Six quality measures were analyzed: colon cancer, breast cancer, cervical cancer, diabetes Hgb A1C, diabetes eye, and diabetes nephropathy monitoring. Based on US Preventative Services Task Force screening guidelines, we determined which patients were due for at least one of the quality measures. We tracked completion rates during three time periods: pre-pandemic (January 1–March 3, 2020), stay-at-home (March 4–May 8, 2020), and phased reopening (May 9–July 8, 2020). Differences in quality measure completion rates were evaluated using mixed-effects logistic regression models. Compared to pre-pandemic rates, completion of all health screenings declined during the stay-at-home period: mammograms (OR: 0.34; 95% CI: 0.31–0.37), cervical cancer (OR: 0.83; 95% CI: 0.76–0.91), colorectal cancer (OR: 0.25; 95% CI: 0.23–0.28), diabetes eye (OR: 0.34; 95% CI: 0.29–0.41), diabetes Hgb A1c (OR: 0.41; 95% CI: 0.37–0.46), and diabetes nephropathy (OR: 0.46, 95% CI: 0.41–0.53). During phased reopening, completion of all quality measures increased compared to the stay-at-home period, except for cervical cancer screening (OR: 0.83; 95% CI: 0.76–0.92). There was a persistent reduction in completion of all quality measures, except for diabetic nephropathy monitoring (OR: 0.99; 95% CI: 0.89–1.09), during phased reopening compared to pre-pandemic. Healthcare screening rates were reduced during the early part of the COVID-19 pandemic and did not fully recover to pre-pandemic rates by July 2020. Future research should aim to clarify the long-term impacts of delayed health screenings. New interventions should be considered for expanding remote preventative health services. 

/pdf/impact-of-covid-19-on-primary-care-quality-measures-in-an-2npjuuwh.pdf

Impact of COVID-19 on Primary Care Quality Measures in an Academic Integrated Health System

Key Points Question Is the intersection of race, ethnicity, rurality, and/or neighborhood disadvantage associated with outcomes among US patients with diabetic foot ulcers? Findings In this cohort study of 124 487 patients hospitalized with diabetic foot ulcers, 17.6% underwent major (above-ankle) leg amputation or died within 30 days of hospital discharge; proportions increased to 18.3% for rural patients and 21.9% for those identifying as Black. The proportion increased to 28.0% for patients who identified as both rural and Black, suggesting a role for intersectionality. Meaning This study suggests that the intersection of rural residence and identifying as Black is associated with an amplified risk of major leg amputation or death among US patients with diabetic foot ulcers.

/pdf/association-of-race-ethnicity-and-rurality-with-major-leg-3tzkfbv7.pdf

Association of Race, Ethnicity, and Rurality With Major Leg Amputation or Death Among Medicare Beneficiaries Hospitalized With Diabetic Foot Ulcers

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention. 

/pdf/cancer-screening-prevalence-and-associated-factors-among-us-3iv9uriw.pdf

Cancer Screening Prevalence and Associated Factors Among US Adults

One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

https://www.mdpi.com/1660-4601/18/4/1384/pdf

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States.

Introduction Many sociodemographic factors affect women's ability to meet cancer screening guidelines. Our objective was to examine which sociodemographic characteristics were associated with women meeting US Preventive Services Task Force (USPSTF) guidelines for breast, cervical, and colorectal cancer screening. Methods We used 2018 Behavioral Risk Factor Surveillance System data to examine the association between sociodemographic variables, such as race/ethnicity, rurality, education, and insurance status, and self-reported cancer screening for breast, cervical, and colorectal cancer. We used multivariable log-binomial regression models to estimate adjusted prevalence ratios and 95% CIs. Results Overall, the proportion of women meeting USPSTF guidelines for breast, cervical, and colorectal cancer screening was more than 70%. The prevalence of meeting screening guidelines was 6% to 10% greater among non-Hispanic Black women than among non-Hispanic White women across all 3 types of cancer screening. Women who lacked health insurance had a 26% to 39% lower screening prevalence across screening types than women with health insurance. Compared with women with $50,000 or more in annual household income, women with less than $50,000 in annual household income had a 3% to 8% lower screening prevalence across all 3 screening types. For colorectal cancer, the prevalence of screening was 7% less among women who lived in rural counties than among women in metropolitan counties. Conclusion Many women still do not meet current USPSTF guidelines for breast, cervical, and colorectal cancer screening. Screening disparities are persistent among socioeconomically disadvantaged groups, especially women with low incomes and without health insurance. To increase the prevalence of cancer screening and reduce disparities, interventions must focus on reducing economic barriers and improving access to care.

/pdf/disparities-in-meeting-uspstf-breast-cervical-and-colorectal-45594kyysl.pdf

Disparities in Meeting USPSTF Breast, Cervical, and Colorectal Cancer Screening Guidelines Among Women in the United States.

https://journals.sagepub.com/doi/pdf/10.1177/00333549211013320

Gabriel A Benavidez

Papers

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States.

Disparities in Meeting USPSTF Breast, Cervical, and Colorectal Cancer Screening Guidelines Among Women in the United States.

Complexities of COVID-19 Demonstrate the Need for More Interdisciplinary Research Training in Graduate School.