Julia Ramirez

Body Site Is a More Determinant Factor than Human Population Diversity in the Healthy Skin Microbiome

We studied skin microbiota present in three skin sites (forearm, axilla, scalp) in men from six ethnic groups living in New York City. Methods. Samples were obtained at baseline and after four days following use of neutral soap and stopping regular hygiene products, including shampoos and deodorants. DNA was extracted using the MoBio Power Lyzer kit and 16S rRNA gene sequences determined on the IIlumina MiSeq platform, using QIIME for analysis. Results. Our analysis confirmed skin swabbing as a useful method for sampling different areas of the skin because DNA concentrations and number of sequences obtained across subject libraries were similar. We confirmed that skin location was the main factor determining the composition of bacterial communities. Alpha diversity, expressed as number of species observed, was greater in arm than on scalp or axilla in all studied groups. We observed an unexpected increase in α-diversity on arm, with similar tendency on scalp, in the South Asian group after subjects stopped using their regular shampoos and deodorants. Significant differences at phylum and genus levels were observed between subjects of the different ethnic origins at all skin sites. Conclusions. We conclude that ethnicity and particular soap and shampoo practices are secondary factors compared to the ecological zone of the human body in determining cutaneous microbiota composition.

“Doctor, What Do I have?” Knowledge of Cancer Diagnosis Among Immigrant/Migrant Minorities

This study explores patient knowledge of cancer diagnosis among underserved immigrant/migrant minorities. Patients were recruited at a hospital-based cancer clinic in New York City. Demographic and self-reported diagnosis and treatment information were collected; charts were reviewed to ascertain cancer diagnosis. Four hundred thirty-four patients were included. Eighty-seven percent preferred to speak a language other than English in the health care setting. Sixteen percent had incorrect knowledge of their cancer diagnosis. Multivariate analysis indicated that both preference for a non-English language and diagnosis of a “below the belt” cancer were jointly predictive of incorrect knowledge (LR = 17.01; p = 0.0002). “Below the belt” cancers included bladder, colorectal, gynecological, penile, prostate, and testicular cancers. Among this cohort of immigrant/migrant cancer patients, a considerable proportion was unaware of their correct cancer diagnoses. This may have a significant impact on subsequent cancer education, treatment, and care. Limited-English-proficiency patients may be at particular risk.

Association of socioeconomic and practical unmet needs with self-reported nonadherence to cancer treatment appointments in low-income Latino and Black cancer patients

Objective. Treatment adherence, with minimal numbers of missed appointments, is an important determinant of survival among cancer patients. This study aims to determine if unmet financial, logistic, and supportive care needs predict self-reported adherence to cancer treatment appointments of chemotherapy and/or radiation among low-income ethnic minority patients. Design. The sample included 1098 underserved Latino and Black patients recruited from cancer clinics in New York City through the Cancer Portal Project. Participants completed a survey which included sociodemographic, health-related questions and a needs assessment, in their preferred language. Patients’ adherence to chemotherapy and/or radiation treatment appointments was assessed using a self-report. Results. A sample of 1098 patients (581 Latino and 517 Black cancer patients) was recruited. Forty-two Latino cancer patients (7.4%) and 78 Black cancer patients (15.5%) reported missing treatment appointments. Patients, who experienced four or more unmet needs (odds ratios [OR] = 2.02–3.36), and those with unmet housing needs (OR = 3.10–3.31), were more likely to report missing cancer treatment appointments, regardless of their ethnicity/race. Black patients with unmet supportive care (OR = 2.27) and health insurance needs (OR = 3.80) were more likely to miss appointments. Amongst Latinos, legal health-related issues (OR = 2.51) was a significant predictor of missed appointments. Conclusions. Among ethnic minority cancer patients, unmet socioeconomic and supportive care needs, housing needs in particular, predicted patient-reported missed radiation, and/or chemotherapy appointments. Future research should focus on exploring the impact of practical and supportive unmet needs on adherence and development of interventions aiming to improve cancer treatment adherence.

Health-Related Quality of Life of Food-Insecure Ethnic Minority Patients With Cancer

PURPOSE The association between food insecurity and health-related quality of life (QOL) of racial/ethnic minority patients with cancer has not been examined. The purpose of this study is to determine the relationship between food insecurity and health-related QOL reported by racial/ethnic minority patients with cancer. METHODS A consecutive sample of 1,390 underserved ethnic minority patients receiving cancer care in 10 cancer clinics and hospitals in New York City participated in this study. Health-related QOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G) and food security was assessed by the US Department of Agriculture Core Food Security Module. RESULTS Of the 1,390 patients, 581 (41.8%) were classified as food secure, 571 (41.1%) with low food security, and 238 (17.1%) with very low food security. Health-related QOL decreased with each lower food security level. Patient self-reported physical, functional, social, and emotional well-being subscale scores decrease significantly with increasing food insecurity. After controlling for demographic and medical-related factors, the decreases in QOL, physical, functional, social and emotional well-being scores with increasing food insecurity remained significant. CONCLUSION Food insecurity was associated with lower QOL in this sample of underserved racial/ethnic minority patients with cancer. Underserved ethnic minority patients diagnosed with cancer are a vulnerable patient population, at significant risk for inadequate food access and the related lower QOL.

Psychosocial correlates of appointment keeping in immigrant cancer patients.

This study aims to determine the psychosocial correlates of self-reported adherence to cancer treatment appointments and treatment delays and interruptions. The sample included 622 immigrant cancer patients from New York City. Patients completed a survey that included sociodemographic and health-related questions, questions assessing missed appointments and delays/or interruptions, and quality of life and depression scales. After controlling for sociodemographic characteristics, having a positive depression screen and poor physical and emotional well-being were significant predictors of missed appointments and delays and/or interruptions of treatment. Non-adherence to treatment appointments in immigrant cancer patients is a complex outcome related to important modifiable or treatable factors.

Dental Care Access for Low-Income and Immigrant Cancer Patients in New York City

This exploratory study assesses the dental care needs and access of low-income, mostly immigrant cancer patients enrolled in New York City’s Integrated Cancer Care Action Network (ICCAN). A nested cohort of patients from ICCAN responded to a dental needs assessment that surveyed current dental health as well as access to, and use of, dental services. 373 patients participated. Self-report of having a dentist to visit, current dental problems, income, and insurance most significantly predicted a dentist visit in the past year. Discussing treatment-related oral side effects with the oncologist greatly increased the likelihood of seeing a dentist, but few patients reported having had this conversation. There is a lack of oral care information flowing from oncologists to low income patients. We found a high number of reported dental problems: concerning because of potential treatment interference and risk for infection. Finally, ability to pay largely determined dental care access in our study participants.

Doctor, what do I have? Limited-English–proficient patients and cancer diagnosis knowledge.

6100 Background: Screening, diagnosis and treatment have significantly reduced the cancer burden of several cancers in the US for certain populations. Incorrect knowledge of cancer diagnosis can hinder treatment. Immigrant minorities and the underserved face unique challenges in the receipt of appropriate cancer care. Barriers to understanding cancer diagnoses include language, culture, and health literacy. This study investigates knowledge of cancer diagnosis among immigrant minorities. METHODS Patients were recruited at ten hospital-based cancer clinics in New York City between September 2008 and December 2010. Bilingual staff administered a survey for a sample of 471 patients with a clinical cancer diagnosis. Demographic and self-reported diagnosis and treatment information were collected. Patient charts were reviewed to ascertain cancer diagnosis. RESULTS 92% of patients were foreign-born. 81% preferred to speak a language other than English in the health care setting. 64% of foreign-born patients had resided in the US for 15 years or less. 25% were uninsured. Among those who were insured, 50% had Medicaid only, and 39% had Medicaid for Emergency Services only. 60% did not have a primary care provider, and 84% did not have a social worker assisting them with their care. The most common cancer diagnoses were breast (28%), colorectal (9%), cervical (8%), and lung (7%). 14% had incorrect knowledge of their cancer diagnosis. An additional 6 participants reported the correct metastatic site, but wrong primary cancer, or correct site, but wrong type of cancer. Of the 68 patients with incorrect knowledge of their diagnosis, 91% preferred a non-English language in the health care setting. CONCLUSIONS Among this cohort of predominantly immigrant cancer patients, a considerable proportion were unaware of their correct cancer diagnoses. This may have a significant impact on subsequent cancer treatment and care. Language discordance likely has an important role in this miscommunication between patients and the health care system. Limited English proficient patients may be at particular risk for suboptimal cancer care. More research is needed to better understand cancer care in the language discordant encounter.

Abstract A59: Sociodemographic predictors for poor quality of life among urban minority oncology patients

Introduction: This study investigates sociodemographic predictors of low quality of life among a cohort of predominately underserved, minority oncology patients. Given the positive effects of a higher quality of life on patients’ survival rates, as well as the growing body of data supporting the effectiveness of psychosocial interventions in improving both quality of life and survival rates, the ability to quickly identify patients at risk for lower quality of life is critical. Establishing specific risk factors has the potential to help providers connect patients for whom psychosocial interventions may be especially beneficial to support services early in the course of their treatment. Methods: We analyzed demographic, sociocultural, and quality of life data – measured with the Functional Assessment of Cancer Therapy Scale (General) (FACT-G) – from a consecutive sample of 265 oncology patients participating in an individualized patient-navigation program at the Center for Immigrant Health and Cancer Disparities at Memorial Sloan-Kettering Cancer Center. Data was collected in-person during enrollment interviews by bilingual program staff. Results: The majority of the patients were female (68%); were born in Latin America (47%), the Caribbean (21%), the U.S. (16%), or Asia (9%); and preferred to speak English (43%), Spanish (38%), or Chinese (Mandarin, Cantonese, or Fujianese) (8%) in the healthcare setting. More than a third of patients had less than a high school education (39%) and 22% were unemployed before their diagnosis. The most common cancer diagnoses were breast (32%), colorectal (12%), gynecological (cervical, uterine, ovarian, or vulvar) (12%), lymphoma (6%), lung (5%), and prostate (5%). Patients who were foreign-born and who preferred to speak a language other than English in the healthcare setting were more likely to report lower quality of life (p = .015, p = .002, respectively). Similarly, patients who said they spoke English well, very well, or fluently had a higher quality of life than those who spoke it not well or not at all (p = .004). Patients who were employed at the time of interview and/or reported higher monthly incomes also had a significantly higher quality of life (p = .040, p = Conclusions: These results highlight the fact that low-income immigrant oncology patients are at a higher risk for lower quality of life than their higher-income and U.S.-born peers, which may potentially put them at risk for poorer outcomes. While there has been significant progress in developing psychosocial interventions such as support groups and counseling tailored to oncology patients, much less has been done to target the specific and significant psychosocial needs of immigrant and minority patients. Given the fact that lower-income and minority patients continue to experience both lower quality of life and poorer outcomes than their higher-income and white counterparts, more research and interventions are needed to address the interrelationship between quality of life and outcomes, particularly the effect that targeted improvements in quality of life may have on the survival rates of low-income, immigrant, and minority patients. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A59.