The role of area deprivation index in health care disruptions among cancer survivors during the SARS-CoV-2 pandemic.

OBJECTIVE: To examine the associations between demographic/medical and geographic factors with follow-up medical care and health-related quality of life (HRQoL) among cancer survivors during the SARS-CoV-2 pandemic. STUDY DESIGN: Cross-sectional survey. METHODS: An online survey was sent to cancer survivors between May 2020 and January 2021, exploring their experience with SARS-CoV-2, follow-up care, and HRQoL. PolicyMap was used to geocode home addresses. Both geographic and demographic/medical factors were examined for their associations with SARS-CoV-2 experience, follow-up care, and HRQoL (FACT-G7). RESULTS: Geographic data were available for 9651 participants. Patients living in the highest area deprivation index (ADI) neighborhoods (most deprived) had higher odds of avoiding in-person general (odds ratio [OR] = 7.20; 95% confidence interval [CI] = 2.79-18.60), cancer (OR = 8.47; 95% CI = 3.73-19.30), and emergency (OR = 14.2; 95% CI = 5.57-36.30) medical care, as well as lower odds of using telemedicine (OR = 0.61; 95% CI = 0.52-0.73) compared to the lowest ADI group. Race/ethnicity was not associated with follow-up care after controlling for ADI. The effect of ADI on HRQoL was generally in the expected direction, with higher ADI being associated with worse HRQoL. CONCLUSIONS: ADI influenced follow-up medical care more than age, race/ethnicity, or health insurance type. Healthcare providers and institutions should focus on decreasing barriers to in-person and telemedicine health care that disproportionally impact those living in more deprived communities, which are exacerbated by health care disruptions like those caused by the SARS-CoV-2 pandemic.

Pre-transplant emotional support is associated with longer survival after allogeneic hematopoietic stem cell transplantation.

Emerging evidence suggests that psychosocial factors pre-transplant predict survival in cancer patients undergoing hematopoietic stem cell transplantation (HSCT). These studies, however, typically have small sample sizes, short-term follow ups or a limited panel of medical covariates. We extend this research in a large, well-characterized sample of transplant patients, asking whether patients' perceived emotional support and psychological distress predict mortality over 2 years. Prior to transplant, 400 cancer patients (55.5% males; 82.8% White; Mage=50.0 years; 67.0% leukemia, 20.0% lymphoma) were interviewed by a social caseworker, who documented the patients' perceived emotional support and psychological distress. Subsequently, patients received an allogeneic HSCT (51.0% matched-related donor, 42.0% matched-unrelated donor and 7.0% cord blood). HSCT outcomes were obtained from medical records. Controlling for demographic characteristics (age, sex, race/ethnicity and marital status) and medical confounders (disease type, conditioning regimen, remission status, cell dosage, donor and recipient CMV seropositivity, donor sex, comorbidities and disease risk), ratings of good emotional support pre-transplant predicted longer overall survival (hazard ratio (HR)=0.61, 95% confidence interval (CI), 0.42-0.91; P=0.013). Pre-transplant psychological distress was unrelated to survival, however (Ps>0.58). Emotional support was marginally associated with lower rates of treatment-related mortality (HR=0.58, CI, 0.32-1.05; P=0.073). These findings are consistent with the hypothesis that emotional support contributes to better outcomes following HSCT. Future studies should examine whether intervention efforts to optimize emotional resources can improve survival in cancer patients.

Perceived stress is associated with CD4+ cell decline in men and women living with HIV/AIDS in Spain.

This study assessed whether perceived stress as measured by the Perceived Stress Scale (PSS) was associated with a decline in CD4+ cell counts over a six-month period in 59 men and 41 women living with HIV-1. Participants underwent psychological and medical assessment at the study entry (baseline) and again at six months post-baseline. In a hierarchical regression model controlling for sociodemographic (e.g. age, gender, education, income) and disease-related variables (e.g. duration of antiretroviral treatment, antiretroviral treatment and adherence, CD4+ cell count and viral load), perceived stress was associated with the decline in CD4+ cell count over the six-month period. These findings suggest perceived psychosocial stress is associated with CD4+ cell count decline independent of sociodemographic factors and disease status among men and women on antiretroviral medication for HIV/AIDS.

Psychiatric symptoms and HIV risk in MMPI-2 cluster subgroups of polysubstance abusers in treatment.

This-investigation identified personality subgroups based upon cluster analysis of MMPI-2 records of polysubstance abusers. Subgroups were compared on lifetime and current psychiatric symptoms and on attitudes and behaviors linked with HIV infection risk. High psychopathology, mild psychopathology, and subclinical MMPI-2 cluster types were identified which resemble those that have been identified in earlier studies with the original version of the MMPI. The High Psychopathology Subgroup had significantly higher proportions with all lifetime psychiatric problems (ASI), higher levels of all current psychiatric symptoms (SCL-90), and lower levels of confidence in ability to enact safer sexual practices than the Subclinical Cluster Subgroup. Fewer differences in lifetime and concurrent psychiatric symptoms were found in comparisons involving High Pathology and Mild Pathology cluster subgroups and Mild Psychopathology and Subclinical cluster subgroups. Those in the High Psychopathology Subgroup likely need treatment programs that address their more chronic and serious mental health problems and interventions that target their judgment and problem solving limitations that may increase HIV infection risk.