Bhav Jain is pursuing an MD at the Stanford School of Medicine as a Knight-Hennessy Scholar, Harry S. Truman Scholar, and Samvid Scholar. He graduated from the Massachusetts Institute of Technology (MIT) with a bachelor’s degree in computer science and brain and cognitive sciences. At MIT, he was a Legatum Fellow and received the 40 Under 40 in Cancer Award.
His research on healthcare delivery, social determinants of health, and value-based care has been published in outlets such as Nature Medicine, The Lancet Digital Health, JAMA Oncology, Journal of the National Cancer Institute, American Journal of Public Health, Cancer, Journal of the American College of Surgeons, Journal of General Internal Medicine, and American Journal of Managed Care. While at MIT, he launched The Connected Foundation, which forges intergenerational connections between youth and seniors, and Compass, an SMS platform that streamlines patient intake and scheduling. Most recently, he served as a Fellow at the Boston Public Health Commission to implement interventions aimed at curbing substance abuse and homelessness. As a physician-policymaker, Bhav aspires to create high-value, evidence-based healthcare systems that transform clinical care globally. In particular, he seeks to innovate at both public- and private-sector organizations during his career to improve the quality of and lower the cost of patient care.
Access and barriers to genomic classifiers for breast cancer and prostate cancer in India.
International journal of cancer
The incidence of cancer in general, including breast and prostate cancer specifically, is increasing in India. Breast and prostate cancers have genomic classifiers developed to guide therapy decisions. However, these genomic classifiers are often inaccessible in India due to high cost. These classifiers may also be less suitable to the Indian population, as data primarily from patients in wealthy Western countries were used in developing these genomic classifiers. In addition to the limitations in using these existing genomic classifiers, developing and validating new genomic classifiers for breast and prostate cancer in India is challenging due to the heterogeneity in the Indian population. However, there are steps that can be taken to address the various barriers that currently exist for accurate, accessible genomic classifiers for cancer in India.
View details for DOI 10.1002/ijc.34784
View details for PubMedID 37962056
Trends in Location of Death for Individuals With Ovarian Cancer in the United States.
Obstetrics and gynecology
Using the publicly available Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database from 2003 to 2019, we evaluated associations between decedent characteristics and location of death for patients with ovarian malignancy. We found that Black, Native American, Asian American, and Hispanic patients were more likely to die in hospitals than White patients, despite an overall reduction in hospital deaths and an overall increase in hospice facility deaths. Additionally, patients with lesser educational attainment were more likely to die in nursing facilities and less likely to die in hospice facilities. Although there may be some contribution from cultural preferences, these findings may represent disparities in access to palliative care affecting people with cancer from racial and ethnic minoritized groups.
View details for DOI 10.1097/AOG.0000000000005439
View details for PubMedID 37944156
Trends and Determinants of Location of Death Due to Colorectal Cancer in the United States : A Nationwide Study.
Annals of surgical oncology
Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States (US); however, there are limited data on location of death in patients who die from CRC. We examined the trends in location of death and determinants in patients dying from CRC in the US.We utilized the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to extract nationwide data on underlying cause of death as CRC. A multinomial logistic regression was performed to assess associations between clinico-sociodemographic characteristics and location of death.There were 850,750 deaths due to CRC from 2003 to 2019. There was a gradual decrease in deaths in hospital, nursing home, or outpatient facility/emergency department over time and an increase in deaths at home and in hospice. Relative to White decedents, Black, Asian, and American Indian/Alaska Native decedents were less likely to die at home and in hospice compared with hospitals. Individuals with lower educational status also had a lower risk of dying at home or in hospice compared with in hospitals.The gradual shift in location of death of patients who die of CRC from institutionalized settings to home and hospice is a promising trend and reflects the prioritization of patient goals for end-of-life care by healthcare providers. However, there are existing sociodemographic disparities in access to deaths at home and in hospice, which emphasizes the need for policy interventions to reduce health inequity in end-of-life care for CRC.
View details for DOI 10.1245/s10434-023-14337-y
View details for PubMedID 37907701
View details for PubMedCentralID 4192888
- ASO Visual Abstract: Trends and Determinants of Location of Death Due to Colorectal Cancer in the USA: A Nationwide Study. Annals of surgical oncology 2023
- Delays in Time to Surgery Among Asian and Pacific Islander Women with Breast Cancer. Annals of surgical oncology 2023; 30 (9): 5337-5340
Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups.
Annals of surgical oncology
2023; 30 (9): 5495-5505
Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients.We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0-III colon cancer receiving surgery at ≥ 60 days versus 30-59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors.Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01-1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09-1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01-1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17-1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04-1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20-1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17-1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22-1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02-1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36-1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups.Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.
View details for DOI 10.1245/s10434-023-13339-0
View details for PubMedID 37017832
View details for PubMedCentralID PMC10075171
- ASO Author Reflections: Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders. Annals of surgical oncology 2023; 30 (9): 5506-5508
- Revamping Public Health Systems: Lessons Learned from the "Triple-demic". American journal of preventive medicine 2023
- A holistic framework to integrate HIV and cardiovascular disease care in sub-Saharan Africa AIDS 2023; 37 (10): 1497-1502
- Disparities in Breast-Conserving Therapy Versus Mastectomy Among Asian American and Pacific Islander Women. Annals of surgical oncology 2023; 30 (7): 3894-3897
- Trends in location of death for individuals with metastatic lung cancer in the United States. American journal of surgery 2023; 226 (1): 135-137
A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
2023; 31 (7): 420
In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.
View details for DOI 10.1007/s00520-023-07886-1
View details for PubMedID 37354234
View details for PubMedCentralID 3705700
- Disparities in Receipt of Mental Health Services and Mental Distress Among Patients with Chronic Obstructive Pulmonary Disease JOURNAL OF GENERAL INTERNAL MEDICINE 2023
Localized prostate cancer disparities in risk group at presentation and access to treatment for Hispanic men.
Prostate cancer and prostatic diseases
2023; 26 (2): 309-316
Despite great heterogeneity amongst Hispanic groups, prostate cancer studies often report Hispanic patients in aggregate. We sought to identify differences in prostate cancer risk group at presentation and treatment status among Hispanic subgroup populations.Patients with localized prostate adenocarcinoma diagnosed from 2004-2017 were identified in the National Cancer Database (NCDB) and disaggregated by racial subgroup and Hispanic country of origin. Ordinal logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment with intermediate-unfavorable or high-risk disease.In our sample (n = 895,087), Hispanic men had greater odds of presenting with higher-risk localized prostate cancer compared with non-Hispanic White men (AOR = 1.18 95% CI 1.16-1.21, p < 0.001). Additionally, Hispanic Black men were less likely to present with higher-risk disease than non-Hispanic Black men. Disparities also existed when disaggregated by country of origin, particularly for Mexican men. Amongst men with unfavorable-risk disease, Hispanic men were less likely to receive treatment than non-Hispanic White men (95% CI 0.57-0.67, p < 0.001). The odds of Hispanic Black patients receiving treatment was 2.00 times the odds (95% CI 1.17-3.41 p = 0.011) of non-Hispanic Black patients receiving treatment. Upon disaggregation by country of origin, disparities persisted, particularly for Mexican men.We found marked heterogeneity when risk group at presentation and treatment for higher-risk disease were disaggregated by racial subgroup and country of origin. Our findings support further collection of disaggregated data in Hispanic communities and study of potential mechanisms underlying the observed differences.
View details for DOI 10.1038/s41391-022-00526-5
View details for PubMedID 35306541
View details for PubMedCentralID 6547116
- Crossing Borders: Improving Mental Health Outcomes in Asian American Immigrants With Cancer. JCO oncology practice 2023; 19 (5): 234-237
The impact of commercial health datasets on medical research and health-care algorithms
LANCET DIGITAL HEALTH
2023; 5 (5)
View details for Web of Science ID 001030852600001
The impact of commercial health datasets on medical research and health-care algorithms.
The Lancet. Digital health
2023; 5 (5): e288-e294
As the health-care industry emerges into a new era of digital health driven by cloud data storage, distributed computing, and machine learning, health-care data have become a premium commodity with value for private and public entities. Current frameworks of health data collection and distribution, whether from industry, academia, or government institutions, are imperfect and do not allow researchers to leverage the full potential of downstream analytical efforts. In this Health Policy paper, we review the current landscape of commercial health data vendors, with special emphasis on the sources of their data, challenges associated with data reproducibility and generalisability, and ethical considerations for data vending. We argue for sustainable approaches to curating open-source health data to enable global populations to be included in the biomedical research community. However, to fully implement these approaches, key stakeholders should come together to make health-care datasets increasingly accessible, inclusive, and representative, while balancing the privacy and rights of individuals whose data are being collected.
View details for DOI 10.1016/S2589-7500(23)00025-0
View details for PubMedID 37100543
- Epistemic equity in oncology: Opportunities to leverage patient-centric implementation in clinical trial design. Cancer 2023; 129 (9): 1313-1315
- Spending It Forward: Integrated Public Health Investments Are Vital to the Pandemic Response. Journal of public health management and practice : JPHMP 2023; 29 (4): 430-432
- China Needs Evidence-Based COVID Vaccines, and Its Government Now Has a Political Opening to Provide Them. Journal of public health management and practice : JPHMP 2023; 29 (3): 281-283
Total Joint Arthroplasty Utilization After Orthopaedic Surgery Referral: Identifying Disparities Along the Care Pathway.
The Journal of arthroplasty
2023; 38 (3): 424-430
Although racial and ethnic disparities in total joint arthroplasty (TJA) have been thoroughly described, only a few studies have sought to determine exactly where along the care pathway these disparities are perpetuated. The purpose of this study was to investigate disparities in TJA utilization occurring after patients who had diagnosed hip or knee osteoarthritis were referred to a group of orthopaedic providers within an integrated academic institution.A retrospective, multi-institutional study evaluating patients with diagnosed hip or knee osteoarthritis was conducted between 2015 and 2019. Information pertaining to patient demographics, timing of clinic visits, and subsequent surgical intervention was collected. Utilization rates and time to surgery from the initial clinic visit were calculated by race, and logistic regressions were performed to control for various demographic as well as health related variables.White patients diagnosed with knee osteoarthritis were significantly more likely to receive total knee arthroplasty (TKA) than Black and Hispanic patients, even after adjusting for various demographic variables (Black patients: odds ratio [OR] = 0.63, 95% CI = 0.55-0.72, P = .002; Hispanic patients: OR = 0.69, 95% CI = 0.57-0.83, P = .039). Similar disparities were found among patients diagnosed with hip osteoarthritis who underwent total hip arthroplasty (THA; Black patients: OR = 0.73, 95% CI = 0.60-0.89, P = <.001; Hispanic patients: OR = 0.72, 95% CI = 0.53-0.98, P <.001). There were no differences in time to surgery between races (P > .05 for all).In this study, racial and ethnic disparities in TJA utilization were found to exist even after referral to an orthopaedic surgeon, highlighting a critical point along the care pathway during which inequalities in TJA care can emerge. Similar time to surgery between White, Black, and Hispanic patients suggest that these disparities in TJA utilization may largely be perpetuated before surgical planning while patients are deciding whether to undergo surgery. Further studies are needed to better elucidate which patient and provider-specific factors may be preventing these patients from pursuing surgery during this part of the care pathway.Level IV.
View details for DOI 10.1016/j.arth.2022.09.020
View details for PubMedID 36150431
The Enhancing Oncology Model: Leveraging improvement science to increase health equity in value-based care.
Journal of the National Cancer Institute
2023; 115 (2): 125-130
The Oncology Care Model (OCM), launched in 2016 by the Centers for Medicare and Medicaid Services, was the first demonstration of value-based payment in oncology. Although the OCM delivered mixed results in terms of quality of care and total episode costs, the model had no statistically significant impact on remediating racial, ethnic, and socioeconomic disparities among beneficiaries. These deficits have been prominent in other aspects of US healthcare, and as a result, the Institute for Healthcare Improvement has advocated for stakeholders to leverage improvement science, an applied science that focuses on implementing rapid cycles for change, to identify and overcome barriers to health equity. With the announcement of the new Enhancing Oncology Model, a continuation of the OCM's efforts in introducing value to cancer care for episodes surrounding chemotherapy administration, both policymakers and providers must apply tenets of improvement science and make eliminating disparities in alternative payment models a forefront objective. In this commentary, we discuss previous inequities in alternative payment models, the role that improvement science plays in addressing health-care disparities, and steps that stakeholders can take to maximize equitable outcomes in the Enhancing Oncology Model.
View details for DOI 10.1093/jnci/djac194
View details for PubMedID 36245086
View details for PubMedCentralID PMC9905958
- The implications of rising alcohol-associated cancer burden: Considerations for the Indian context. Asia-Pacific journal of clinical oncology 2023; 19 (1): 275-276
Corporate Social Responsibility Framework: An Innovative Solution to Social Determinants of Health in the USA.
Journal of racial and ethnic health disparities
Expand firms' corporate social responsibility (CSR) framework to systematically address social determinants of health (SDOH) in their communities and improve firms' performance (FP). GAP: The U.S. healthcare system has struggled to improve population health outcomes while enhancing delivery performance. An oft-overlooked contributor to this deficit is SDOH inequities, accounting for 25-60% of deaths in the USA annually. Ironically, most healthcare firms do not view investment in SDOH, a neglected phenomenon, to develop sustainable healthy communities as their direct responsibility due to the "wrong pocket problem." Although extant literature theorizes the CSR construct, there is a paucity of research on SDOH integration with the CSR framework.We integrate a quantitative and qualitative study with supplementary literature on CSR and SDOH using the grounded theory method by researching fourteen health plan firms across the USA.Research reveals early efforts undertaken by top-performing healthcare insurers to address SDOH and provides evidence that such measures can be integrated profitably under CSR as a competitive advantage.Contributes to CSR theory and practice by providing an empirical model and expanding its framework to address SDOH systematically. Key implications are as follows: (1) healthcare firms to link with unconventional partners, such as housing authorities, food banks, employment agencies, and schools; (2) the entire healthcare supply chain to collaborate with social enterprises and regulators to develop sustainable communities; (3) policymakers must incentivize firms to align social equity and corporate goals; and (4) long-term view on CSR, SDOH, and healthy living (HL) will in-turn eliminate social inequities while enhancing FP.
View details for DOI 10.1007/s40615-022-01493-2
View details for PubMedID 36689122
Fragile X Syndrome Patient-Derived Neurons Developing in the Mouse Brain Show FMR1-Dependent Phenotypes.
2023; 93 (1): 71-81
Fragile X syndrome (FXS) is characterized by physical abnormalities, anxiety, intellectual disability, hyperactivity, autistic behaviors, and seizures. Abnormal neuronal development in FXS is poorly understood. Data on patients with FXS remain scarce, and FXS animal models have failed to yield successful therapies. In vitro models do not fully recapitulate the morphology and function of human neurons.To mimic human neuron development in vivo, we coinjected neural precursor cells derived from FXS patient-derived induced pluripotent stem cells and neural precursor cells derived from corrected isogenic control induced pluripotent stem cells into the brain of neonatal immune-deprived mice.The transplanted cells populated the brain and a proportion differentiated into neurons and glial cells. Immunofluorescence and single and bulk RNA sequencing analyses showed accelerated maturation of FXS neurons after an initial delay. Additionally, we found increased percentages of Arc- and Egr-1-positive FXS neurons and wider dendritic protrusions of mature FXS striatal medium spiny neurons.This transplantation approach provides new insights into the alterations of neuronal development in FXS by facilitating physiological development of cells in a 3-dimensional context.
View details for DOI 10.1016/j.biopsych.2022.08.020
View details for PubMedID 36372569
- Community Paramedicine: An Innovative Model for Value-Based Care Delivery. Journal of public health management and practice : JPHMP 2022; 29 (2): E65-E68
Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
2022; 30 (11): 8905-8917
There has been little research on the healthcare cost-related coping mechanisms of families of patients with cancer. Therefore, we assessed the association between a cancer diagnosis and the healthcare cost-related coping mechanisms of participant family members through their decision to forego or delay seeking medical care, one of the manifestations of financial toxicity.Using data from the National Health Interview Survey (NHIS) between 2000 and 2018, sample weight-adjusted prevalence was calculated and multivariable logistic regressions defined adjusted odds ratios (aORs) for participant family members who needed but did not get medical care or who delayed seeking medical care due to cost in the past 12 months, adjusting for relevant sociodemographic covariates, including participant history of cancer (yes vs. no) and participant age (18-45 vs. 46-64 years old). The analysis of family members foregoing or delaying medical care was repeated using a cancer diagnosis * age interaction term.Participants with cancer were more likely than those without a history of cancer to report family members delaying (19.63% vs. 16.31%, P < 0.001) or foregoing (14.53% vs. 12.35%, P = 0.001) medical care. Participants with cancer in the 18 to 45 years old age range were more likely to report family members delaying (pinteraction = 0.028) or foregoing (pinteraction < 0.001) medical care. Other factors associated with cost-related coping mechanisms undertaken by the participants' family members included female sex, non-married status, poorer health status, lack of health insurance coverage, and lower household income.A cancer diagnosis may be associated with familial healthcare cost-related coping mechanisms, one of the manifestations of financial toxicity. This is seen through delayed/omitted medical care of family members of people with a history of cancer, an association that may be stronger among young adult cancer survivors. These findings underscore the need to further explore how financial toxicity associated with a cancer diagnosis can affect patients' family members and to design interventions to mitigate healthcare cost-related coping mechanisms.
View details for DOI 10.1007/s00520-022-07234-9
View details for PubMedID 35877007
View details for PubMedCentralID 3107566
Racial disparities in treatment delay among younger men with prostate cancer.
Prostate cancer and prostatic diseases
2022; 25 (3): 590-592
Young men (≤55 years) with prostate cancer (PC) may experience treatment delays despite clinical consequences of delays beyond six months. Using the United States National Cancer Database (2004-2017), we employed multivariable logistic regression analysis to retrospectively examine racial disparities in localized PC treatment delays >6 months since diagnosis. Of the 89,196 men ≤55 years included, young Black men experienced treatment delays beyond six months more frequently than young White men (7.39% vs. 3.96%; AOR 1.95, 95% CI 1.81-2.09, p < 0.001), a disparity that was greater than that among men ages 56-64 (pinteraction < 0.001). This result persisted upon restricting the sample to men with private insurance/managed care. The finding that Black men with localized PC experienced treatment delays almost twice as frequently as White men underscores access barriers that may go beyond the direct costs of care.
View details for DOI 10.1038/s41391-021-00479-1
View details for PubMedID 35190652
View details for PubMedCentralID 4191828
- The Novel Adenovirus: A Call for Advances in Health Infrastructure and Pandemic Preparedness. Journal of public health management and practice : JPHMP 2022; 28 (6): 603-606
Assessment of Compliance With Centers for Medicare & Medicaid Services Price Transparency Final Rule.
2022; 8 (8): 1212-1213
This cross-sectional study assesses disclosures of commercial payer-negotiated rates in compliance with Centers for Medicare & Medicaid Services new final ruling effective January 1, 2022.
View details for DOI 10.1001/jamaoncol.2022.1783
View details for PubMedID 35679019
View details for PubMedCentralID PMC9185506
Disparities in timely treatment among young women with breast cancer.
American journal of surgery
2022; 224 (2): 811-815
Although evidence suggests worse breast cancer-specific survival associated with treatment delay beyond 90 days, little is known regarding the sociodemographic predictors of delays in cancer-directed surgery among young women with breast cancer. This is particularly notable, given that 5-10% of new diagnoses occur in younger women aged <40 years, commonly with more aggressive features than in older women.We used the National Cancer Database (2004-2017) to assess sociodemographic disparities in delay of upfront surgery beyond 90 days among young women with non-metastatic breast cancer, using multivariable logistic regression and predictive marginal modeling.Black women experienced treatment delays more frequently than white women (aOR: 1.93 [95% CI: 1.76-2.11], p < 0.001). Adjusted rates of treatment delay were 4.91% [95% CI: 4.51%-5.30%] and 2.60% [95% CI: 2.47%-2.74%] for Black and white women, respectively, and 2.97% [95% CI: 2.83%-3.12%], 2.36% [95% CI: 2.03%-2.68%], and 1.18% [95% CI: 0.54%-1.81%] for women from metro, urban, and rural areas, respectively.These results suggest that improving access to timely treatment may be leveraged as a means through which to lessen the breast cancer disparities experienced by Black women.
View details for DOI 10.1016/j.amjsurg.2022.01.019
View details for PubMedID 35090684
View details for PubMedCentralID PMC9304449
Integrated practice units present an opportunity over siloed survivorship care settings.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
2022; 30 (8): 6375-6379
Given the rapidly rising cancer burden in the USA, the need to innovate survivorship care for oncology patients is rising rapidly. The current body of empirical evidence in survivorship care has focused on care provided by general practitioners (GP) and specialists/surgeons (SS). In particular, current evaluations address cost of care, cancer recurrence, quality of life, and overall survival of patients, with results indicating no statistically significant differences in GP- and SS-led care models and little emphasis on the broader characteristics of care settings. We fill this gap in survivorship care by introducing a perspective on the potential for holistic care delivery with a multidisciplinary team approach at integrated practice units (IPUs). Additionally, we propose a comprehensive examination of survivorship care across GP-, SS-, and IPU-led settings to provide researchers and practitioners with solid ground to determine the optimal survivorship care model, considering four key characteristics: (1) operating mode and skills, (2) cost and accountability of care, (3) health outcome measurement, and (4) workflow and scheduling.
View details for DOI 10.1007/s00520-022-06964-0
View details for PubMedID 35290514
View details for PubMedCentralID 4709150
- Trends in location of death for individuals with primary brain tumors in the United States. Neuro-oncology 2022; 24 (8): 1400-1401
- Payer-Negotiated Prices for Breast Cancer Treatment at NCI-Designated Cancer Treatment Centers. Annals of surgical oncology 2022; 29 (6): 3381-3383
- ASO Research Letter: Trends in Location of Death for Individuals with Pancreatic Cancer in the United States. Annals of surgical oncology 2022; 29 (5): 2766-2768
- Orthogeriatric co-management care models: The need for integrated practice units. The Lancet regional health. Western Pacific 2022; 21: 100416
- Racial disparities in senior healthcare: System-level interventions. Journal of the American Geriatrics Society 2022; 70 (4): 1292-1296
Socioeconomic disparities in healthcare utilization for atherosclerotic cardiovascular disease.
American heart journal
2022; 246: 161-165
The impact of the social determinants of health on healthcare utilization for patients with atherosclerotic cardiovascular disease (ASCVD) remains incompletely characterized.We queried the National Health Interview Survey from 2000-2018 to examine disparities in healthcare utilization metrics by education, income-to-poverty ratio, and health insurance coverage for adults with self-reported ASCVD.We show that, while education and income-to-poverty ratios demonstrated significant disparities for provider visits and preventive screenings, the largest disparities were noted for health insurance coverage.These trends suggest that efforts to expand private or government insurance to improve coverage for patients with ASCVD may address healthcare utilization-based disparities.
View details for DOI 10.1016/j.ahj.2022.01.011
View details for PubMedID 35093303
Weight gain after in vitro fertilization: a potential consequence of controlled ovarian stimulation.
Journal of assisted reproduction and genetics
2022; 39 (4): 973-976
In the USA, 42% of adult women were estimated to have obesity, and 13% of women of childbearing age similarly have impaired fecundity. Obesity is associated with infertility such that patients with obesity often seek out in vitro fertilization (IVF) services. Here, we report on the case of a woman with childhood-onset class II obesity who had been undergoing treatment with phentermine and topiramate prior to undergoing 3 cycles of IVF. With each cycle, the patient temporarily gained 13-15 lbs. during controlled ovarian stimulation (COS). Weight gain from COS may be clinically relevant and merits further study to optimize weight status across women's reproductive life and to better assist women who gain weight secondary to IVF. Incorporating weight monitoring into IVF protocols may also help better characterize the scope of weight gain from COS.
View details for DOI 10.1007/s10815-022-02444-w
View details for PubMedID 35218460
View details for PubMedCentralID PMC9051006
Overcoming congressional inertia on obesity requires better literacy in obesity science.
Obesity (Silver Spring, Md.)
2022; 30 (4): 799-801
Obesity-focused health policies, including the landmark Treat and Reduce Obesity Act, have stalled at the federal level over the past decade. Congressional inaction on obesity reflects both misconceptions of obesity as a lifestyle choice and limited awareness for the burden obesity imposes on our health care system. Given these challenges, we argue that health professionals must bolster their efforts to partner with public figures with obesity and to directly educate the public. These strategies may help destigmatize obesity and build awareness of obesity as a disease. Furthermore, we suggest that these strategies may empower patients to flex their unrealized political muscle and demand more from their elected leaders. A bold, multilevel approach that elicits a public demand for change can propel obesity policy into the 21st century.
View details for DOI 10.1002/oby.23405
View details for PubMedID 35244978
View details for PubMedCentralID PMC8957554
Randomized clinical trials of weight loss: Pragmatic and digital strategies and innovations.
Contemporary clinical trials
2022; 114: 106687
During the COVID-19 pandemic, digital strategies and decentralized approaches allowed for the continuation of weight loss clinical trials despite in-person engagement coming to a halt. In particular, trials leveraged remote mediums to measure data in real-time across a broad array of metrics while testing novel strategies to streamline patient care. Such approaches may address longstanding challenges with traditional trials, including attrition and underrepresentation of racial and ethnic minorities. Ultimately, emerging data from trials utilizing both digital and in-person strategies may indicate the promise of a hybrid approach in incorporating a robust virtual component for continuous patient monitoring and an in-person component for patient adherence and data standardization. In this commentary, we provide an overview of the most innovative digital approaches in clinical trials of weight loss during the COVID-19 era, as well as identify opportunities and challenges for these modes of research going forward.
View details for DOI 10.1016/j.cct.2022.106687
View details for PubMedID 35085830
View details for PubMedCentralID PMC8785263
Rural-Urban Differences in Influenza Vaccination Among Adults in the United States, 2018-2019.
American journal of public health
2022; 112 (2): 304-307
Objectives. To provide adjusted rates of self-reported receipt of the influenza vaccine in the 2018-2019 flu season among adults in large metropolitan, medium and small metropolitan, and nonmetropolitan areas of the United States by age group, gender, and race. Methods. We queried the 2019 National Health Interview Survey for respondents aged 18 years and older. To provide national estimates of influenza vaccination coverage, we performed sample-weighted multivariable logistic regressions and predicted marginal modeling while adjusting for age, gender, race/ethnicity, and urban-rural household designation. Results. After weighting, 48.1%, 46.2%, and 43.6% of adults from large metropolitan, small and medium metropolitan, and nonmetropolitan areas, respectively, received the influenza vaccine. Additionally, there was a trend toward declining influenza vaccination status from large metropolitan to rural areas in all age groups, both genders, and multiple racial/ethnic groups. Conclusions. Self-reported influenza vaccination rates were lower in rural than in urban areas among adults of all age groups and both genders. Using community leaders for health promotion, augmentation of the community health care workforce, and provision of incentives for providers to integrate influenza vaccination in regular visits may expand influenza vaccine coverage. (Am J Public Health. 2022;112(2):304-307. https://doi.org/10.2105/AJPH.2021.306575).
View details for DOI 10.2105/AJPH.2021.306575
View details for PubMedID 35080958
View details for PubMedCentralID PMC8802596
- All Infrastructure Is Health Infrastructure AMERICAN JOURNAL OF PUBLIC HEALTH 2022; 112 (1): 24-26
- Global health responsibilities in a Taliban-led Afghanistan. Nature medicine 2021
Prostate Cancer Disparities in Risk Group at Presentation and Access to Treatment for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study With Disaggregated Ethnic Groups.
JCO oncology practice
We identified (1) differences in localized prostate cancer (PCa) risk group at presentation and (2) disparities in access to initial treatment for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) men with PCa after controlling for sociodemographic factors.We assessed all patients in the National Cancer Database with localized PCa with low-, intermediate-, and high-risk disease who identified as Thai, White, Asian Indian, Chinese, Vietnamese, Korean, Japanese, Filipino, Hawaiian, Pacific Islander, Laotian, Pakistani, Kampuchean, and Hmong. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment or active surveillance with intermediate- or high-risk disease, adjusting for sociodemographic and clinical factors.Among 980,889 men (median age 66 years), all AANHPI subgroups with the exception of Thai (AOR = 0.84 [95% CI, 0.58 to 1.21], P > .05), Asian Indian (AOR = 1.12 [95% CI, 1.00 to 1.25], P > .05), and Pakistani (AOR = 1.34 [95% CI, 0.98 to 1.83], P > .05) men had greater odds of presenting at a progressively higher PCa risk group compared with White patients (Chinese AOR = 1.18 [95% CI, 1.11 to 1.25], P < .001; Japanese AOR = 1.36 [95% CI, 1.26 to 1.47], P < .001; Filipino AOR = 1.37 [95% CI, 1.29 to 1.46], P < .001; Korean AOR = 1.32 [95% CI, 1.18 to 1.48], P < .001; Vietnamese AOR = 1.20 [95% CI, 1.07 to 1.35], P = .002; Laotian AOR = 1.60 [95% CI, 1.08 to 2.36], P = .018; Hmong AOR = 4.07 [95% CI, 1.54 to 10.81], P = .005; Kampuchean AOR = 1.55 [95% CI, 1.03 to 2.34], P = .036; Asian Indian or Pakistani AOR = 1.15 [95% CI, 1.07 to 1.24], P < .001; Native Hawaiians AOR = 1.58 [95% CI, 1.38 to 1.80], P < .001; and Pacific Islanders AOR = 1.58 [95% CI, 1.37 to 1.82], P < .001). Additionally, Japanese Americans (AOR = 1.46 [95% CI, 1.09 to 1.97], P = .013) were more likely to receive treatment compared with White patients.Our findings suggest that there are differences in PCa risk group at presentation by race or ethnicity among Asian American, Native Hawaiian, and Pacific Islander subgroups and that there exist disparities in treatment patterns. Although AANHPI are often studied as a homogenous group, heterogeneity upon subgroup disaggregation underscores the importance of further study to assess and address barriers to PCa care.
View details for DOI 10.1200/OP.21.00412
View details for PubMedID 34709962
Whether the weather will help us weather the COVID-19 pandemic: Using machine learning to measure twitter users' perceptions.
International journal of medical informatics
2021; 145: 104340
The potential ability for weather to affect SARS-CoV-2 transmission has been an area of controversial discussion during the COVID-19 pandemic. Individuals' perceptions of the impact of weather can inform their adherence to public health guidelines; however, there is no measure of their perceptions. We quantified Twitter users' perceptions of the effect of weather and analyzed how they evolved with respect to real-world events and time.We collected 166,005 English tweets posted between January 23 and June 22, 2020 and employed machine learning/natural language processing techniques to filter for relevant tweets, classify them by the type of effect they claimed, and identify topics of discussion.We identified 28,555 relevant tweets and estimate that 40.4 % indicate uncertainty about weather's impact, 33.5 % indicate no effect, and 26.1 % indicate some effect. We tracked changes in these proportions over time. Topic modeling revealed major latent areas of discussion.There is no consensus among the public for weather's potential impact. Earlier months were characterized by tweets that were uncertain of weather's effect or claimed no effect; later, the portion of tweets claiming some effect of weather increased. Tweets claiming no effect of weather comprised the largest class by June. Major topics of discussion included comparisons to influenza's seasonality, President Trump's comments on weather's effect, and social distancing.We exhibit a research approach that is effective in measuring population perceptions and identifying misconceptions, which can inform public health communications.
View details for DOI 10.1016/j.ijmedinf.2020.104340
View details for PubMedID 33242762
View details for PubMedCentralID PMC7654388