Ann Marie Flores

Looking under the Hispanic umbrella: cancer mortality among Cubans, Mexicans, Puerto Ricans and other Hispanics in Florida.

Cancer is the second leading cause of death among Hispanics. Most of the cancer statistics available both at the state and national levels report cancer statistics for all Hispanics as an aggregate group. The goal of this paper is to provide a population-based overview of cancer mortality among Hispanics (Cubans, Mexicans, Puerto Ricans and other Hispanics) in Florida from 1990 to 2000 and to explore the demographic diversity of this growing ethnic group. The study population consisted of Hispanics and White non-Hispanics who died from cancer. Cancer mortality rates and proportion of cancer deaths by type and age at death for the selected racial/ethnic groups were calculated. Our findings indicate that the cancer death rates of the Hispanic subgroups compared favorably with those of White non-Hispanics and that cancer rates often presented for all Hispanics mask important differences between the different ethnic subgroups that fall under the Hispanic umbrella.

How receptive are patients with late stage cancer to rehabilitation services and what are the sources of their resistance

OBJECTIVE To describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, and the rationale for their level of interest. DESIGN Prospective mixed-methods study. SETTING Comprehensive cancer center in a quaternary medical center. PARTICIPANTS Adults with stage IIIC or IV non-small cell or extensive stage small cell lung cancer (N=311). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Telephone-acquired responses to the administration of (1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); (2) numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; (3) a query regarding receptivity to receipt of rehabilitation services, and (4) a query about rationale for nonreceptivity. RESULTS Overall, 99 (31.8%) of the studys 311 participants expressed interest in receiving rehabilitation services: 38 at the time of enrollment and an additional 61 during at least 1 subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs 9.91%, P=.04) and a musculoskeletal comorbidity (42.4% vs 31.6%, P=.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns. CONCLUSIONS One-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.

Physical impairments and physical therapy services for minority and low-income breast cancer survivors

PurposeWe describe impairments after breast cancer and its treatment for African American (AA), non-Hispanic white and low-income breast cancer survivors (BCS) and whether physical therapy (PT) was utilized to address these impairments.MethodsBCS from the Southern Community Cohort Study (SCCS) were surveyed about self-reported BC treatment-related impairments (shoulder impairment, muscle weakness, pain, fatigue, skin numbness, abnormal posture) and referral to PT for impairments. We compared impairments by race, income and PT utilization. We used a cross-sectional design.ResultsAmong 528 BCS interviewed (266 whites; 262 AA), mean age 64, those with low incomes were more likely to report muscle weakness, pain and postural abnormalities, and a greater total number of impairments than those with higher incomes. Racial differences were few. PT utilization tended to be low, with AAs more likely than whites to utilize PT if they had shoulder impairment or pain, whereas no monotonic trends across income levels were seen in PT utilization.ConclusionsLow-income level was associated with greater prevalence of BC-related physical impairments, but not higher PT utilization. There appears to be a possible under-utilization of PT, particularly for those with low incomes.

Recommendations for patient-reported outcome measures for head and neck cancer-related shoulder dysfunction: A systematic review

Background: Patients with head and neck cancer (HNC) often experience significant postoperative limitations in shoulder function and ability to participate in daily activities due to spinal accessory nerve (SAN) damage. Physical therapists must use valid and reliable outcome measures to quantify functional outcomes related to treatment of the shoulder. Purpose: As part of the activities of the Oncology Section Head and Neck EDGE Task Force, we report evidence‐based recommendations for patient‐reported outcome measures for patients with HNC‐related shoulder dysfunction. Methods: We conducted a systematic literature review of shoulder outcome measures that are clinically feasible and relevant to the HNC patient population using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) model. Recommendations are based on the quality of psychometric properties, clinical feasibility, and previous use in HNC‐related research. Sixteen outcome measures were reviewed and five are recommended [Disabilities of the Arm, Shoulder and Hand (DASH), Neck Dissection Impairment Index (NDII), Shoulder Pain and Disability Index (SPADI), University of Washington Quality of Life (UW‐QOL) shoulder subscale, and QuickDASH] for use in the HNC population. Conclusions: There were strengths and weaknesses related to each of the recommended outcome measures. The DASH, QuickDASH and the SPADI demonstrate strong psychometric properties across multiple patient populations, but have been minimally used in the HNC population. The NDII and UW‐QOL were specifically developed for the HNC population but have not been fully tested. Further research should address the efficacy and appropriateness of these measures for use in patient populations presenting with shoulder dysfunction in the setting of HNC. Systematic Review Registration Number: PROSPERO CRD42013004898

Shoulder impairment before breast cancer surgery.

Objective:To compare pre- and postoperative shoulder active range of motion (AROM) values from female breast cancer (BCA) survivors to population norm values for shoulder AROM, and to compare shoulder AROM differences pre- and postsurgery between female African American (AA) and white BCA survivors. Study Design:This pilot study used a convenience sample and longitudinal design measuring participants 2 times (T0 = baseline, after biopsy but within 2 weeks before BCA; T1 = second postoperative week). Background:The United States has the largest BCA survivor population in history, but the mortality burden remains highest among AA BCA survivors. African Americans may also have a greater burden of physical and functional adverse effects compared with whites and the general population. Methods and Measures:The data were collected from a convenience sample (n = 33; nAA= 9, nW= 24) and included data on shoulder AROM, medical chart review for pre- and comorbid conditions, and self-reported demographics and medical history. We used t tests to compare sample AROM means to population norms. We then compared our sample across 2 time points (T0 = presurgery; T1 = 2 weeks postsurgery) using independent samples t tests and repeated-measures analysis of variance (P < .05) to compare AA with white subsamples AROM means. Results:African Americans had significantly less shoulder abduction (at T0) and flexion (at T1) than whites. However, 100% had significantly reduced AROM for all movements at T0 (prior to surgery but after biopsy) when compared with population norms. Conclusions:The significant reduction in shoulder AROM after biopsy but before surgery points to a possible unmet need for early physical therapy intervention. Further research using randomized controlled trial design is recommended.

EDGE Task Force on Head and Neck Cancer Outcomes A Systematic Review of Outcome Measures for Quantifying External Lymphedema

Background: Survivors of head and neck cancer (HNC) and its treatment experience high rates of lymphedema. Unlike the extremities, the head and neck is difficult to measure and does not easily lend itself to having a contralateral side for comparison. Being an irregularly shaped part of the body, measures of edema for the extremities cannot be adapted for the head and neck. The need exists for outcome measures to objectively quantify head and neck lymphedema using evidence‐based practice guidelines. Purpose: The purpose of this study is to identify and recommend external edema outcome measures for lymphedema in the HNC population. Methods: A systematic review of the literature on edema measures for use in the HNC patient population was conducted. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) model was used to guide which articles were chosen for inclusion, determination of eligibility, screening, and identification for the final review. Recommendations are based on the quality of psychometric properties, clinical feasibility, and previous use in HNC‐related research. Six edema outcome measures were reviewed and none are recommended at this time; however, several hold great promise for future use in the clinic. Conclusions: This systematic review provides an overview for physical therapists on measures of external edema for the HNC patient population. The edema measures included in this review have been tested on HNC patients but have not been rigorously tested due to their novelty. At this time, no outcome measures for objectively quantifying external edema for the HNC population can be recommended. There is need for more research on this topic prior to providing definitive recommendations. Systematic Review Registration Number: PROSPERO CRD42013004898

Edge Task Force on Head and Neck Cancer Outcomes: A Systematic Review of Outcome Measures for Temporomandibular-related Dysfunction

Background: Patients with head and neck cancer (HNC) often experience significant postoperative limitations in temporomandibular joint (TMJ) function, facial pain, reduced nutritional intake, speech impairments, and compromised activities of daily living due to side effects of cancer treatment. Physical therapists treating these individuals must use valid and reliable patientreported outcome measures to quantify change related to physical therapy intervention for the TMJ. Purpose: As part of the activities of the Oncology Section EDGE Task Force on Head and Neck Cancer Outcomes, we report evidence‐based recommendations for patient‐reported outcome measures for individuals with HNC‐related temporomandibular dysfunction (TMD). Methods: A systematic literature review of TMD‐related patient‐reported outcome measures that are clinically feasible and relevant to the HNC patient population was conducted using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) model. Recommendations are based on the quality of psychometric properties, clinical utility, and previous use in HNC‐related research. Twenty‐two outcome measures were selected for review; 4 received a rating of 3, “recommended” for use in the HNC population. Conclusions: A variety of outcome measures have been reported in the literature for individuals with HNC‐related TMD. Four measures, the Graded Chronic Pain Scale, 8 and 20‐item Jaw Functional Limitation Scale and TMD Pain Screener, are recommended for clinical use by the researchers on this task force although it is important to note psychometric properties specific to the HNC population are lacking. Systematic Review Registration Number: PROSPERO CRD42013004898

Abstract A60: Preliminary findings from the Southern Community Cancer Survivorship Study: Disparities in late effects, Part 1

Purpose: The purpose of this study is to describe preliminary findings of breast cancer specific physical and functional limitations among African Americans (AAs), whites (Ws), poor, and medically underserved breast cancer survivors (BCS) living in the Southern United States. Methods and Data: We partner with the Southern Community Cohort Study (SCCS) and are enrolling SCCS participants who are breast cancer survivors. We have enrolled 320 individuals who have completed our computer-assisted telephone interview (CATI). Over 80% were originally recruited by the SCCS from community health centers and the remainder was recruited from the general population. All are enrolled from the 12 states included in the SCCS (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia). The survey focuses on breast cancer specific physical and functional recovery after treatment. We report the preliminary findings on variables related to sociodemographics, range of motion, lymphedema signs and symptoms, and cancer treatment. We use descriptive statistics and Chi-square tests of independence to summarize our preliminary data. Results: Of our 313 AA or W participants, 49.2% are AAs. Slightly more than half of both groups (AA:53%, W:56%, p=.603) had more than a HS equivalent education. The Ws tended to be older on average (M=66.0, SD=8.6 years) than the AAs (M=62.8, SD=8.3 yrs, p=.001).A higher proportion of AAs than Ws tended to be the primary financial provider of the household (71.4% vs. 53.5%, p = .001), earn

U.S. Latino Population Composition Change and Comprehensive Cancer Centers

30,000 or less per year (73.4% vs. 54.7%, p = .001), and reported to be on disability (29.2% vs. 11.9%, p (p = .048). Approximately 99% of the respondents had surgical treatment of some type with no statistically significant differences between AAs and Ws in terms of type of surgery or in number of lymph nodes removed. AA BCS were more likely than Ws to have reported swelling in the affected side (47.4% vs. 28.3%, p p p p Significance: Our study suggests that AA BCS may experience a heavier burden of late effects of cancer treatment and have less financial means to help mitigate this burden. The next step is to use multivariate approaches to determine whether these disparities persist when accounting for other important control variables such as age, time since diagnosis, and level of comorbidity. African American, poor and medically underserved have often not been included in epidemiologic research and our study will provide critical data useful towards the development of interventions aimed at the eventual reduction in cancer survivorship burden due to breast cancer related physical and functional impairments. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A60.

ROUND: Table Discussion: Physical Therapy and Outcome Measures

Background. We describe a typology characterizing population trends of U.S. Latinos/Hispanics from 1990 to 2000 with respect to National Cancer Institute-designated comprehensive cancer centers (CCCs) and corresponding consolidated metropolitan statistical or metropolitan statistical areas (CMSA/MSAs). Methods. Using U.S. Census Bureau data, we constructed population pyramids to analyze population growth and composition for each CMSA/MSA with a CCC. Results. We identified four types of population growth and composition: Type I—Very Fast and Unstable; Type II—Fast and Unstable; Type III— Somewhat Fast and Stable; Type IV—Slow and Stable. Conclusions. The CCCs in areas with Types I and II population growth face the greatest challenges because of the lack of infrastructure for reaching medically underserved Latinos. In contrast, CCCs in areas with Types III and IV population growth may have significant infrastructure but must quickly develop interventions to reach and provide access to aging Latinos to reduce health disparities in cancer mortality and morbidity.