Presence of Multi-Morbidities and Colorectal Cancer Screening Utilization among Breast Cancer Survivors
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Study Participants
2.3. Guideline-Concordant CRC Screening: Outcome of Interest
2.4. Chronic Diseases Conditions: Primary Exposure of Interest
2.5. Covariates of Interest: Sociodemographic Characteristics, Quality of Life, and Cancer-Related Factors
2.6. Statistical Analysis
3. Results
3.1. CRC Screening Utilization
3.2. The Relationship of Multi-Morbidities on CRC Screening Utilization
4. Discussion
4.1. Chronic Disease Conditions on CRC Screening
4.2. Other Covariates of Interest in CRC Screening
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Chronic Diseases One to Two (n = 702) | Chronic Diseases One to Two (n = 388) | Chronic Diseases Three or More (n = 234) | |
---|---|---|---|
n | n | n | |
Education | 0 | 1 | 1 |
Income | 118 | 60 | 36 |
Provider | 15 | 5 | 7 |
Treatment summary | 56 | 27 | 24 |
Follow-up care plan | 17 | 5 | 8 |
References
- Millar, M.M.; Edwards, S.L.; Herget, K.A.; Orleans, B.; Ofori-Atta, B.S.; Kirchhoff, A.C.; Carter, M.E.; Nagata, M.; Sweeney, C. Adherence to Guideline-Recommended cancer screening among Utah cancer survivors. Cancer Med. 2022, 12, 3543–3554. [Google Scholar] [CrossRef]
- American Cancer Society (ACS). Cancer Facts & Figures 2022; American Cancer Society: Atlanta, GA, USA, 2022. [Google Scholar]
- Lai, J.H.; Park, G.; Gerson, L.B. Association between breast cancer and the risk of colorectal cancer. Gastrointest. Endosc. 2017, 86, 429–441.e1. [Google Scholar] [CrossRef] [PubMed]
- Geng, F.; Liu, M.; Chen, J.; Ge, Y.; Wei, S.; Li, F.; Yang, C.; Sun, J.; Gou, L.; Zhang, J.; et al. Clinical characteristics of second primary malignancies among first primary malignancy survivors: A single-center study, 2005–2020. Oncol. Lett. 2023, 25, 24. [Google Scholar] [CrossRef] [PubMed]
- Corkum, M.; Hayden, J.A.; Kephart, G.; Urquhart, R.; Schlievert, C.; Porter, G. Screening for new primary cancers in cancer survivors compared to non-cancer controls: A systematic review and meta-analysis. J. Cancer Surviv. 2013, 7, 455–463. [Google Scholar] [CrossRef] [Green Version]
- Macacu, A.; Autier, P.; Boniol, M.; Boyle, P. Active and passive smoking and risk of breast cancer: A meta-analysis. Breast Cancer Res. Treat. 2015, 154, 213–224. [Google Scholar] [CrossRef] [Green Version]
- Deng, Z.; Jones, M.R.; Wang, M.C.; Visvanathan, K. Mortality after second malignancy in breast cancer survivors compared to a first primary cancer: A nationwide longitudinal cohort study. NPJ Breast Cancer 2022, 8, 82. [Google Scholar] [CrossRef]
- Nyrop, K.A.; Damone, E.M.; Deal, A.M.; Carey, L.A.; Lorentsen, M.; Shachar, S.S.; Williams, G.W.; Brenizer, A.; Wheless, A.; Muss, H.B. Obesity, comorbidities, and treatment selection in Black and White women with early breast cancer. Cancer 2021, 127, 922–930. [Google Scholar] [CrossRef] [PubMed]
- Kang, D.; Kang, M.; Hong, Y.S.; Park, J.; Lee, J.; Seo, H.J.; Kim, D.W.; Ahn, J.S.; Park, Y.H.; Lee, S.K.; et al. Temporal patterns of chronic disease incidence after breast cancer: A nationwide population-based cohort study. Sci. Rep. 2022, 12, 5489. [Google Scholar] [CrossRef] [PubMed]
- Schneider, K.M.; O’Donnell, B.E.; Dean, D. Prevalence of multiple chronic conditions in the United States’ Medicare population. Health Qual. Life Outcomes 2009, 7, 82. [Google Scholar] [CrossRef] [Green Version]
- Elewonibi, B.; Nkwonta, C. The association of chronic diseases and mammography among Medicare beneficiaries living in Appalachia. Womens Health 2020, 16, 1745506520933020. [Google Scholar] [CrossRef]
- Tsai, M.H.; Moore, J.X.; Odhiambo, L.A.; Andrzejak, S.E.; Tingen, M.S. Colorectal cancer screening utilization among breast, cervical, prostate, skin, and lung cancer survivors. J. Cancer Surviv. 2022. [Google Scholar] [CrossRef] [PubMed]
- Shay, L.A.; Schmidt, S.; Dioun, S.I.; Grimes, A.; Embry, L. Receipt of a survivorship care plan and self-reported health behaviors among cancer survivors. J. Cancer Surviv. 2019, 13, 180–186. [Google Scholar] [CrossRef]
- Ko, E.; Zuniga, M.L.; Woodruff, S.I.; Serra-Martinez, Y.; Cardenas, V. Development of a Survivorship Care Plan (SCP) Program for Rural Latina Breast Cancer Patients: Proyecto Mariposa-Application of Intervention Mapping. Int. J. Environ. Res. Public Health 2020, 17, 5784. [Google Scholar] [CrossRef] [PubMed]
- Tsai, M.H.; Bevel, M.S.; Andrzejak, S.E. Racial/Ethnic Disparity in the Relationship of Mental and Physical Health with Colorectal Cancer Screening Utilization Among Breast and Prostate Cancer Survivors. JCO Oncol. Pract. 2023, OP2200718. [Google Scholar] [CrossRef]
- Arneja, J.; Brooks, J.D. The impact of chronic comorbidities at the time of breast cancer diagnosis on quality of life, and emotional health following treatment in Canada. PLoS ONE 2021, 16, e0256536. [Google Scholar] [CrossRef]
- Podvorica, E.; Kraja, J.; Rrustemi, N.; Dugolli, X.; Hyseni, E. Anxiety and Depression in Patients with Breast Cancer: A Cross-sectional Study. Open Access Maced. J. Med. Sci. 2022, 10, 138–143. [Google Scholar] [CrossRef]
- Beau, A.B.; Napolitano, G.M.; Ewertz, M.; Vejborg, I.; Schwartz, W.; Andersen, P.K.; Lynge, E. Impact of chronic diseases on effect of breast cancer screening. Cancer Med. 2020, 9, 3995–4003. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dash, C.; Lu, J.C.; Parikh, V.; Wathen, S.; Shah, S.; Chaudhari, R.S.; Adams-Campbell, L. Disparities in colorectal cancer screening among breast and prostate cancer survivors. Cancer Med. 2021, 10, 1448–1456. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data; Centers for Disease Control and Prevention: Atlanta, GA, USA, 2020.
- Davidson, K.W.; Barry, M.J.; Mangione, C.M.; Cabana, M.; Caughey, A.B.; Davis, E.M.; Donahue, K.E.; Doubeni, C.A.; Krist, A.H.; Kubik, M.; et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2021, 325, 1965–1977. [Google Scholar]
- Wolf, A.M.D.; Fontham, E.T.H.; Church, T.R.; Flowers, C.R.; Guerra, C.E.; LaMonte, S.J.; Etzioni, R.; McKenna, M.T.; Oeffinger, K.C.; Shih, Y.C.T.; et al. Colorectal Cancer Screening for Average-Risk Adults: 2018 Guideline Update From the American Cancer Society. CA A Cancer J. Clin. 2018, 68, 250–281. [Google Scholar] [CrossRef]
- Zhang, Y.X.; Zhao, J.; Jiang, N.; Liu, Y.Y.; Wang, T.; Yu, X.; Wang, J.W.; Yu, J.M. The association between comorbidities and stigma among breast cancer survivors. Sci. Rep. 2022, 12, 13682. [Google Scholar] [CrossRef] [PubMed]
- Greiner, B.; Gandhi, R.; Abrol, R.; Patel, M.; Hartwell, M. National disparities in colorectal cancer screening in patients with comorbid conditions: An analysis of the Behavioral Risk Factor Surveillance System. J. Osteopath. Med. 2021, 121, 657–662. [Google Scholar] [CrossRef] [PubMed]
- Ford, E.S.; Moriarty, D.G.; Zack, M.M.; Mokdad, A.H.; Chapman, D.P. Self-reported body mass index and health-related quality of life: Findings from the behavioral risk factor surveillance system. Obes. Res. 2001, 9, 21–31. [Google Scholar] [CrossRef] [PubMed]
- Zahran, H.S.; Kobau, R.; Moriarty, D.G.; Zack, M.M.; Giles, W.H.; Lando, J.; CDC. Self-reported frequent mental distress among adults—United States, 1993–2001 (Reprinted from MMWR, vol 53, pg 963-966, 1993). JAMA 2004, 292, 2458–2459. [Google Scholar]
- Trask, P.C.; Rabin, C.; Rogers, M.L.; Whiteley, J.; Nash, J.; Frierson, G.; Pinto, B. Cancer screening practices among cancer survivors. Am. J. Prev. Med. 2005, 28, 351–356. [Google Scholar] [CrossRef]
- Bovelli, D.; Plataniotis, G.; Roila, F.; Grp, E.G.W. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. Ann. Oncol. 2010, 21, v277–v282. [Google Scholar] [CrossRef]
- Kwan, M.L.; Cheng, R.K.; Iribarren, C.; Neugebauer, R.; Rana, J.S.; Mai, N.H.; Shi, Z.X.; Laurent, C.A.; Lee, V.S.; Roh, J.M.; et al. Risk of Cardiometabolic Risk Factors in Women with and without a History of Breast Cancer: The Pathways Heart Study. J. Clin. Oncol. 2022, 40, 1635–1646. [Google Scholar] [CrossRef]
- Howell, A.; Anderson, A.S.; Clarke, R.B.; Duffy, S.W.; Evans, D.G.; Garcia-Closas, M.; Gescher, A.J.; Key, T.J.; Saxton, J.M.; Harvie, M.N. Risk determination and prevention of breast cancer. Breast Cancer Res. 2014, 16, 446. [Google Scholar] [CrossRef]
- Mehta, L.S.; Watson, K.E.; Barac, A.; Beckie, T.M.; Bittner, V.; Cruz-Flores, S.; Dent, S.; Kondapalli, L.; Ky, B.; Okwuosa, T.; et al. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect A Scientific Statement From the American Heart Association. Circulation 2018, 137, E30–E66. [Google Scholar] [CrossRef]
- Matthews, A.K.; Tejeda, S.; Johnson, T.P.; Berbaum, M.L.; Manfredi, C. Correlates of Quality of Life Among African American and White Cancer Survivors. Cancer Nurs. 2012, 35, 355–364. [Google Scholar] [CrossRef] [Green Version]
- Deshpande, A.D.; Sefko, J.A.; Jeffe, D.B.; Schootman, M. The association between chronic disease burden and quality of life among breast cancer survivors in Missouri. Breast Cancer Res. Treat. 2011, 129, 877–886. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sogaard, M.; Thomsen, R.W.; Bossen, K.S.; Sorensen, H.T.; Norgaard, M. The impact of comorbidity on cancer survival: A review. Clin. Epidemiol. 2013, 5 (Suppl. 1), 3–29. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vuksanovic, D.; Sanmugarajah, J.; Lunn, D.; Sawhney, R.; Eu, K.; Liang, R. Unmet needs in breast cancer survivors are common, and multidisciplinary care is underutilised: The Survivorship Needs Assessment Project. Breast Cancer 2021, 28, 289–297. [Google Scholar] [CrossRef]
- Williams, A.; Erb-Downward, J.; Bruzelius, E.; O’Hara-Cicero, E.; Maling, A.; Machin, L.; Viera-Delgado, M.; Valera, P.; Maysonet, N.; Weiss, E.S. Exploring cancer screening in the context of unmet mental health needs: A participatory pilot study. Prog. Community Health Partnersh. 2013, 7, 123–134. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hodgkinson, K.; Butow, P.; Hunt, G.E.; Pendlebury, S.; Hobbs, K.M.; Lo, S.K.; Wain, G. The development and evaluation of a measure to assess cancer survivors’ unmet supportive care needs: The CaSUN (Cancer Survivors’ Unmet Needs measure). Psycho.-Oncol. 2006, 16, 796–804. [Google Scholar] [CrossRef]
- Simard, S.; Thewes, B.; Humphris, G.; Dixon, M.; Hayden, C.; Mireskandari, S.; Ozakinci, G. Fear of cancer recurrence in adult cancer survivors: A systematic review of quantitative studies. J. Cancer Surviv. 2013, 7, 300–322. [Google Scholar] [CrossRef] [PubMed]
- Maly, R.C.; Liu, Y.H.; Diamant, A.L.; Thind, A. The Impact of Primary Care Physicians on Follow-up Care of Underserved Breast Cancer Survivors. J. Am. Board Fam. Med. 2013, 26, 628–636. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Total (n = 1324) | One (n = 702) | Two (n = 388) | Three or More (n = 234) | ||||
---|---|---|---|---|---|---|---|
Having CRC screening a | 84.4% | 85.4% | 88.3% | ||||
CRC screening a n (%) b | p-value e | CRC screening a n (%) b | p-value e | CRC screening a n (%) b | p-value e | ||
Sociodemographic characteristics | |||||||
Age | 0.069 | 0.118 | 0.776 | ||||
45–59 | 277 (27.7%) | 120 (84.1%) | 53 (85.8%) | 43 (87.8%) | |||
60–69 | 638 (46.1%) | 291 (81.4%) | 170 (82.3%) | 83 (89.7%) | |||
70–74 | 409 (26.1%) | 179 (90.0%) | 107 (91.8%) | 67 (86.9%) | |||
Race/Ethnicity | <0.001 | <0.001 | <0.001 | ||||
Non-Hispanic White | 1070 (77.5%) | 500 (87.7%) | 264 (83.1%) | 143 (87.5%) | |||
Non-Hispanic Black | 160 (15.4%) | 62 (94.6%) | 50 (95.8%) | 31 (97.1%) | |||
Non-Hispanic Others/Hispanic c | 94 (7.0%) | 28 (33.4%) | 16 (84.9%) | 19 (72.7%) | |||
Education | 0.009 | 0.700 | 0.106 | ||||
High school or lower | 387 (38.8%) | 144 (78.4%) | 158 (84.4%) | 75 (86.0%) | |||
Some college or higher | 935 (60.9%) | 446 (87.6%) | 121 (89.9%) | 117 (91.1%) | |||
Income | 0.003 | 0.202 | 0.686 | ||||
Less than $50,000 | 583 (45.1%) | 201 (79.4%) | 359 (81.4%) | 119 (88.1%) | |||
$50,000 or more | 527 (40.1%) | 292 (88.8%) | 413 (89.1%) | 46 (89.6%) | |||
Quality of life | |||||||
Mental health | <0.001 | <0.001 | <0.001 | ||||
0–13 days | 1157 (83.6%) | 556 (87.8%) | 288 (89.5%) | 142 (92.2%) | |||
14–30 days | 167 (16.4%) | 34 (59.2%) | 42 (60.5%) | 51 (80.1%) | |||
Physical health | <0.001 | 0.570 | 0.695 | ||||
0–13 days | 1050 (78.8%) | 529 (86.8%) | 265 (86.1%) | 103 (88.9%) | |||
14–30 days | 274 (21.2%) | 61 (67.1%) | 65 (83.3%) | 90 (87.6%) | |||
Cancer related factors | |||||||
Cancer treatment insurance | 0.121 | 0.562 | 0.569 | ||||
No | 81 (6.5%) | 27 (72.2%) | 17 (81.8%) | 16 (91.7%) | |||
Yes | 1243 (93.5%) | 563 (85.2%) | 313 (85.7%) | 177 (88.0%) | |||
Current provider type | 0.859 | 0.530 | 0.599 | ||||
Non-general practices d | 390 (30.5%) | 171 (84.1%) | 93 (86.4%) | 59 (86.7%) | |||
General practices | 907 (66.8%) | 411 (84.8%) | 235 (88.9%) | 129 (88.8%) | |||
Treatment summary | 0.427 | 0.469 | <0.001 | ||||
No | 482 (36.6%) | 192 (82.3%) | 121 (83.7%) | 85 (82.6%) | |||
Yes | 735 (55.8%) | 351 (85.0%) | 186 (86.5%) | 90 (93.1%) | |||
Follow-up care plan | 0.544 | 0.517 | <0.001 | ||||
No | 195 (13.4%) | 84 (80.9%) | 46 (83.7%) | 26 (60.0%) | |||
Yes | 1099 (84.1%) | 493 (84.7%) | 280 (87.4%) | 160 (92.6%) |
Total | One | Two | Three or More | |
---|---|---|---|---|
OR (95% CI) a | OR (95% CI) a | OR (95% CI) a | OR (95% CI) a | |
Chronic disease conditions | ||||
One | Reference | NA | NA | NA |
Two | 1.36 (0.74, 2.50) | NA | NA | NA |
Three or more | 2.10 (1.11, 3.98) | NA | NA | NA |
Sociodemographic characteristics | ||||
Age | ||||
45–59 | Reference | Reference | Reference | Reference |
60–69 | 1.30 (0.74, 2.28) | 1.35 (0.66, 2.76) | 1.12 (0.42, 3.01) | 2.27 (0.84, 6.11) |
70–74 | 1.48 (0.75, 2.91) | 1.70 (0.65, 4.45) | 1.81 (0.68, 4.82) | 0.84 (0.36, 1.92) |
Race/Ethnicity | ||||
Non-Hispanic White | Reference | Reference | Reference | Reference |
Non-Hispanic Black | 4.72 (1.69, 13.19) | 4.54 (1.08, 19.11) | 5.17 (2.49, 10.74) | 14.07 (5.61, 35.27) |
Non-Hispanic Others/Hispanic | 0.15 (0.08, 0.27) | 0.04 (0.01, 0.12) | 1.92 (0.55, 6.75) | 0.09 (0.05, 0.17) |
Education | ||||
High school or lower | Reference | Reference | Reference | Reference |
Some college or higher | 1.31 (0.84, 2.06) | 0.75 (0.42, 1.33) | 1.49 (0.80, 2.78) | 4.79 (2.19, 10.47) |
Income | ||||
Less than $50,000 | Reference | Reference | Reference | Reference |
$50,000 or more | 1.50 (0.87, 2.61) | 1.98 (1.08, 3.63) | 1.48 (0.71, 3.08) | 0.99 (0.33, 2.95) |
Quality of life | ||||
Mental health | ||||
0–13 days | Reference | Reference | Reference | Reference |
14–30 days | 0.44 (0.25, 0.76) | 0.68 (0.35, 1.31) | 0.82 (0.29, 2.37) | 0.33 (0.14, 0.74) |
Physical health | ||||
0–13 days | Reference | Reference | Reference | Reference |
14–30 days | 1.05 (0.59, 1.88) | 1.07 (0.51, 2.23) | 0.66 (0.29, 1.51) | 3.32 (1.57, 7.00) |
Cancer related factors | ||||
Cancer treatment insurance | ||||
No | Reference | Reference | Reference | Reference |
Yes | 1.03 (0.52, 2.02) | 3.30 (1.38, 7.89) | 0.51 (0.22, 1.17) | 0.02 (0.002, 0.32) |
Current provider type | ||||
Non- general practices | Reference | Reference | Reference | Reference |
General practices | 1.06 (0.60, 1.86) | 0.75 (0.34, 1.62) | 1.81 (0.66, 4.94) | 2.16 (0.86, 5.45) |
Treatment summary | ||||
No | Reference | Reference | Reference | Reference |
Yes | 0.94 (0.61, 1.45) | 0.92 (0.51, 1.68) | 1.25 (0.57, 2.78) | 3.20 (1.29, 7.92) |
Follow-up care plan | ||||
No | Reference | Reference | Reference | Reference |
Yes | 3.05 (1.68, 5.53) | 2.23 (1.07, 4.66) | 2.07 (0.84, 5.07) | 4.89 (1.92, 12.47) |
Follow-Up Care Plan Yes | Follow-Up Care Plan No | ||||
---|---|---|---|---|---|
n (%) b with/without CRC screening | OR (95%CI) | n (%) b with/without CRC screening | OR (95%CI) | p-value for receiving follow-up care plans within strata of mental/physical health | |
Mental health | |||||
0–13 days | 828 (85.4%)/140 (83.4%) | 1.21 (0.55, 2.68) | 137 (12.5%)/27 (15.2%) | Reference | 0.625 |
14–30 days | 105 (87.0%)/26 (60.9%) | 1.44 (0.64, 3.22) | 19 (9.9%)/12 (29.8%) | 0.08 (0.03, 0.21) | <0.001 |
Physical health | |||||
0–13 days | 758 (85.2%)/122 (72.7%) | 4.87 (1.62, 14.63) | 120 (12.7%)/26 (21.5%) | Reference | 0.006 |
14–30 days | 175 (87.2%)/44 (81.1%) | 8.27 (2.90, 23.56) | 36 (10.0%)/13 (18.5%) | 2.61 (0.88,7.75) | 0.028 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Tsai, M.-H.; Grunert, C.; Vo, J.B.; Moore, J.X.; Guha, A. Presence of Multi-Morbidities and Colorectal Cancer Screening Utilization among Breast Cancer Survivors. Cancers 2023, 15, 2077. https://doi.org/10.3390/cancers15072077
Tsai M-H, Grunert C, Vo JB, Moore JX, Guha A. Presence of Multi-Morbidities and Colorectal Cancer Screening Utilization among Breast Cancer Survivors. Cancers. 2023; 15(7):2077. https://doi.org/10.3390/cancers15072077
Chicago/Turabian StyleTsai, Meng-Han, Caitlyn Grunert, Jacqueline B. Vo, Justin X. Moore, and Avirup Guha. 2023. "Presence of Multi-Morbidities and Colorectal Cancer Screening Utilization among Breast Cancer Survivors" Cancers 15, no. 7: 2077. https://doi.org/10.3390/cancers15072077