ABSTRACT
Background: Although recognized as the most lethal breast cancer, inflammatory breast cancer (IBC), a NCI designated rare cancer and a cancer health disparity, is severely understudied. Given the unique presentation of diffuse tumor spread without a solid mass, not easily detected by selfbreast exams or mammograms, IBC patients often face delays in diagnosis and treatment leading to poor outcomes. Moreover, reproductive risk factors in IBC and high incidence in younger women, minoritized and marginalized populations highlight the significance of primary care providers (PCP) who are often the first point of contact when patients begin to notice symptoms. Method(s): In this study, we evaluated the knowledge gaps and barriers amongst PCP (physicians, physician assistants, nurse practitioners) in their ability to recognize the signs and coordinate care effectively for IBC. To assess PCP experiences with IBC in their practices and overall breast cancer care during COVID, we first conducted semi-structured interviews (n=11) with providers selected from a convenience sample at Duke University and in the local clinics. Based on data from these interviews and additional cognitive interviews, we developed and disseminated a comprehensive online survey (n=78). Result(s): In this study, access to care was identified as the single most important barrier to treating rare cancers. Furthermore, majority of the PCPs in this cohort identified only a moderate ability to recognize IBC in patients (mean = 3.3, range 1-7), thereby limiting early diagnosis. From the semi-structured interviews, PCPs recognized that IBC is not likely to be part of typical differential diagnosis when patients present with mastitis or breast changes, and most had not seen IBC in their practice. Only 31% (n=78) reported ever suspecting IBC in a patient. Delays in referrals to specialized large clinical centers were also reported as a major barrier. In particular, 62.8% (n=49) reported some delay in referrals for diagnostic imaging. In addition, since the COVID-19 pandemic started, 33% reported diagnosing less breast cancer cases and 63% reported that they experienced breast cancer referral delays. When asked what methods providers would find most helpful to learn more about diagnosing and caring for patients with IBC, the top three modes of preferred education were online CME options (53%);lunchtime, or other in-service training (33%);and website for patients and providers (32%). Conclusion(s): We succeeded in developing a survey instrument and to our knowledge first mixed methods study to assess PCP knowledge gaps and barriers to timely diagnosis and care of IBC patients. Results underscore need to develop PCP training modules and care coordination tools to improve guideline-concordant care. This survey instrument also has the potential to serve as a blueprint to design, implement, and evaluate interventions for other rare cancers.
ABSTRACT
BACKGROUND: Obesity continues to be a health concern in the United States, especially among African American (AA) women and those with lower incomes. Cardiovascular diseases are diagnosed at earlier ages in these populations as well. During COVID-19, many supportive services for underserved populations were closed resulting in limited access to healthy dietary choices and exercise. To address these issues, we explored changes in dietary and physical activity habits among older AA women living in public housing communities. METHODS: This was a cross-sectional telephone survey of English-speaking AA women aged ≥55 years who live in public housing communities in central North Carolina. Respondents were asked questions regarding changes to their dietary and exercise habits prior to and after the pandemic. RESULTS: Sixty-one women responded with a mean age of 64.2 years (range 55-83). All responses were asked to compare habits to before the pandemic. Twenty-seven percent (16/61) report eating more healthy;18% (11/61) less healthy;and 55% (33/61) the same. In terms of the amount of food they ate, 25% (15/61) ate more;31% (19/61) ate less;and 44% (27/61) ate the same amount. Those eating more reported doing so due to boredom (8/15);stress/ anxiety (3/15);and due to stay at home orders (4/15). Twenty-one percent (16/ 61) received some of their meals from an outside source such as churches and food pantries;meals were discontinued for 12 women. For snacking frequency, 36% (22/61) report snacking more;21% (13/61) less;and 43% (26/61) the same. Those snacking more often endorsed boredom (8/22);stress/anxiety (2/22);and “because [they are] at home” (6/22). For sugary beverages, 18% (11/61) participants report drinking more;16% (10/61) drinking less;44% (27/ 61) the same;and 21% (13/61) report not drinking sweetened beverages. In terms of exercise, 50% (30/60) report exercising less;3% (2/60) more;and the remaining 47% (28/60) the same amount. Those exercising less note weather (6/30);feeling uncomfortable going to public places (14/30);transportation issues (2/30);stress/anxiety (1/30);and other (18/30). Other responses included chronic medical conditions (8/18). CONCLUSIONS: Compared to before the pandemic, 18% of older AA women in public housing reported they were eating less healthy, with 25% eating more food overall;31% eating less food overall;36% snacking more frequently;and 18% drinking more sugary beverages. For 20%, supplemental meal programs were discontinued, which may have caused them to eat either less food or less healthy options. Further, 50% reported decreased exercise. As the pandemic continues, and services and resources remain limited due to social distancing, these prolonged changes can adversely affect the health of vulnerable populations. There is an urgent need to increase efforts to help older AA women maintain healthy lifestyle habits to help manage their chronic medical conditions.