Electra D. Paskett’s research while affiliated with Columbus State University and other places

Background To date, no studies have examined adherence to the 2018 Physical Activity Guidelines for Americans (PAGA) in real-world longitudinal settings using objectively measured activity monitoring data. This study addresses this gap by using commercial activity monitoring (Fitbit) data from the All of Us dataset. Objective The primary objectives were to describe the prevalence of adherence to the 2018 PAGA and identify associated sociodemographic determinants. Additionally, we compared 3 distinct methods of processing physical activity (PA) data to estimate adherence to the 2008 PAGA. Methods We used the National Institutes of Health’s All of Us dataset, which contains minute-level Fitbit data for 13,947 US adults over a 7-year time span (2015-2022), to estimate adherence to PAGA. A published step-based method was used to estimate metabolic equivalents and assess adherence to the 2018 PAGA (ie, ≥150 minutes of moderate- to vigorous-intensity PA per week). We compared the step-based method, the heart rate–based method, and the proprietary Fitbit-developed algorithm to estimate adherence to the 2008 PAGA. Results The average overall adherence to the 2018 PAGA was 21.6% (3006/13,947; SE 0.4%). Factors associated with lower adherence in multivariate logistic regression analysis included female sex (relative to male sex; adjusted odds ratio [AOR] 0.66, 95% CI 0.60-0.72; P<.001); BMI of 25.0-29.9 kg/m2 (AOR 0.53, 95% CI 0.46-0.60; P<.001), 30-34.9 kg/m2 (AOR 0.30, 95% CI 0.25-0.36; P<.001), or ≥35 kg/m2 (AOR 0.13, 95% CI 0.10-0.16; P<.001; relative to a BMI of 18.5-24.9 kg/m2); being aged 30-39 years (AOR 0.66, 95% CI 0.56-0.77; P<.001), 40-49 years (AOR 0.79, 95% CI 0.68-0.93; P=.005), or ≥70 years (AOR 0.74, 95% CI 0.62-0.87; P<.001; relative to being 18-29 years); and non-Hispanic Black race or ethnicity (AOR 0.63, 95% CI 0.50-0.79; P<.001; relative to non-Hispanic White race or ethnicity). The Fitbit algorithm estimated that a larger percentage of the sample (10,307/13,947, 73.9%; 95% CI 71.2-76.6) adhered to the 2008 PAGA compared to the heart rate method estimate (4740/13,947, 34%; 95% CI 32.8-35.2) and the step-based method (1401/13,947, 10%; 95% CI 9.4-10.6). Conclusions Our results show significant sociodemographic differences in PAGA adherence and notably different estimates of adherence depending on the algorithm used. These findings warrant the need to account for these disparities when implementing PA interventions and the need to establish an accurate and reliable method of using commercial accelerometers to examine PA, particularly as health care systems begin integrating wearable device data into patient health records.

Background The purpose of the Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) Program, a Cancer Moonshot℠ Initiative, is to support research to build the evidence base on multilevel interventions that increase rates of colorectal cancer screening, follow-up, and referral to care to address disparities in colorectal cancer screening. The National Cancer Institute funded eight Research Projects to implement multilevel interventions to improve colorectal cancer screening among communities who traditionally have been medically underserved. To analyze the impact of ACCSIS across Research Projects, the consortium developed a set of common data elements. The purpose of this paper is to describe the process of developing the common data elements to facilitate analysis of ACCSIS data as well as support and inform implementation science research studies. Methods The ACCSIS Data, Design, and Analysis Work Group was tasked with designing common data elements through a review of existing data collection instruments, examination of data elements proposed by the ACCSIS Research Projects, and deliberations on the data required to compare across the Research Projects. ACCSIS Consortium members drafted, revised, and finalized a common data elements document consisting of variables to collect and surveys to administer to evaluate ACCSIS implementation activities and outcomes in a standardized manner across the Research Projects. Results The ACCSIS Consortium decided to collect the following categories of common data elements: characteristics across multiple levels of the multicomponent interventions, implementation climate, and determinants; interventions and strategies; implementation outcome constructs and definitions; colorectal cancer screening episodes (screening, diagnostic testing follow-up, cancer detection, and cancer treatment); and cost measures. To assess implementation climate, the consortium prioritized constructs from five domains of the Consolidated Framework for Implementation Research. Conclusions The ACCSIS common data elements offer a set of harmonization data for future implementation efforts. The consortium is conducting a systematic assessment using both quantitative and qualitative approaches to assess data quality and approaches to improve and sustain data collection. Lessons learned from these ongoing activities will offer additional insights to tailor the ACCSIS common data elements and support efforts to increase colorectal cancer screening for populations experiencing disparities.

Introduction: Health disparities negatively impact outcomes of patients (pts) with hematologic malignancies. Limited retrospective data correlating health disparities with lymphoma outcomes prohibit proper identification of reversible causes and elaboration of potential interventions. We present data from a coordinated effort between the National Clinical Trials Network (NCTN) cooperative groups (Alliance for Clinical Trials in Oncology [Alliance], Eastern Cooperative Oncology Group [ECOG], and the Southwest Oncology Group [SWOG]) to catalog the racial, ethnic, and socioeconomic characteristics of pts with lymphoma to better understand the quality of data collected, analyze selected health disparity indicators, and develop a prospective data collection tool. Methods: We conducted a retrospective analysis of demographic data from pts with lymphoma enrolled on 32 cooperative group therapeutic trials between 2005 and 2020. Special focus was placed on data regarding race, ethnicity, and proxies that help identify socioeconomic status (health insurance, residential zip code, Social Deprivation Index [SDI]). These were evaluated in relation to histology-based metrics from the Surveillance, Epidemiology, and End Results Program (SEER) Program with reported data through 2022. Here, our focus is to characterize baseline demographic and disparities data on the collection of these 32 NCTN lymphoma trials. Results: A total of 3,897 pts were included, with 3,406 non-Hodgkin lymphoma (87.4%) - 1,644 diffuse large B-cell (DLBCL, 48.3%), 905 follicular (26.6%), 669 mantle cell (19.6%), 113 primary central nervous system (3.3%), 75 T-cell (2.2%) - and 491 Hodgkin lymphoma (12.6%). Age at registration was available for 3,891 pts with median age 57.1 years (range: 18-92). The majority of patients were male (58.8%; one pt missing biological sex data). Race data were available for all but one patient, where most pts were white (W, 86.6%), followed by 246 African American (AA, 6.3%), 99 Asian (A, 2.5%), 13 American Indian or Alaska Native (AI, 0.3%), 8 Native Hawaiian or Pacific Islander (PI, 0.2%), 11 with more than 1 race reported (0.3%), and 145 with unknown/not reported race. Ethnicity data were unknown for 327 pts (8.4%) with 179 Hispanic or Latino (Hisp, 4.6%). Combined race/ethnicity data showed 3,010 non-Hisp white (NHW, 77.2%) and 219 non-Hisp black (NHB, 5.6%). For comparison, in the SEER database, 84.7% of all lymphoma cases were W, with 8.6% AA, 5.2% A/PI, 0.4% AI, and 1.1% unknown race, and with 13.9% of pts reported as Hisp. When focusing on the 804 pts enrolled on Alliance CALGB 50303 and ECOG-ACRIN 1412 studies, two randomized DLBCL studies, there was a more proportional representation of W and AA pts with DLBCL - 82.1% and 9.8% compared 84.6% and 7.7%, respectively, at SEER database, with 5.3% Hisp (with another 5.3% unknown) compared to 14.9% at SEER. Insurance information was missing in 113 pts. Of the remainder, 2,102 pts had private insurance only (55.6%), 549 with a mix of private and public (14.5%), 701 public only (18.5%, including 11.4% Medicare, 4.5% Medicaid, 0.8% both), and 166 self-pay (4.4%). Year-matched SDI score was available in 2,885 pts, where higher SDI scores = higher social deprivation. The total mean SDI score for the overall cohort was 42.5 with significant differences observed based on race/ethnicity and insurance type. Specifically, NHW were from less deprived areas (mean SDI=38.8) than NHB (66.4) or Hisp (65.5) (p<0.0001). Those without insurance (mean SDI=52.6) or only public insurance (48.9) were located in areas associated with greater deprivation compared to pts with private (40.1) or public+private (38.8) insurance (p<0.0001). Conclusion: To our knowledge, this is the largest retrospective catalog of racial, ethnic, and socioeconomic characteristics of pts with lymphoma enrolled on cooperative group therapeutic trials. The scope of NCTN cooperative group lymphoma studies provides a unique opportunity to assess novel therapeutic outcomes for patients representing racial, ethnic and socioeconomic subgroups with both common and rare lymphoma subtypes. From this resource, additional analyses on relationships between SDI, race/ethnicity, insurance coverage, disease subtype, and temporal trends will be presented. Support: U10CA180821, U10CA180882, UG1CA189823

Background: Long-term survival for AYA pts [aged 18-39 years (y)] diagnosed with AML remains poor, with only ~50% of pts surviving longer than 5 years despite advances in treatment. AML prognosis is driven mainly by the presence of cytogenetic abnormalities and recurrent gene mutations. However, additional factors reflective of individual lived experience, including socioeconomic contributors and geographic challenges, have also been found to affect survival in population-based studies. These population-based studies use data on large pt cohorts to develop meaningful conclusions, but they lack details on pt-related factors. Understanding the role these contributors play in a rigorously molecularly and socioeconomically characterized cohort, could prove beneficial in identifying potential trends associated with decreased overall survival. Rationale and Methods: A total of 127 AYA pts (median age 31y, range 18-39y) diagnosed with AML at a major Comprehensive Cancer Center (CCC) from 2012-2020 was analyzed. Most pts had cytogenetic data as well as comprehensive clinical and molecular information available. Comprehensive geocoding to yield Yost estimates was performed using factor analysis of all variables by year, each centile rank-transformed prior to analysis, resulting in a single factor (analyses were limited to U.S. states). Yost indices were centile ranked nationally. Home-to-clinic travel time via motorized vehicle was estimated using previous and publicly available methods from Weiss et al. [Nat Med. 2020;26(12):1835-1838] using coordinates of the Ohio State University James Cancer Hospital. Results: In our cohort, 50% of pts were female, and 78%, 10%, 4% self-identified as Non-Hispanic (NH)-White, NH-Black and Hispanic, respectively. The median time to diagnosis was 2 days, the median social deprivation score (national Yost rank) was 52.5, and 26% of pts had a travel time >75 minutes to their treatment center. Univariable analysis using Cox proportional hazards regression models showed that the socioeconomic factors demonstrating the most significant impacts on pt survival included employment status and travel time to a treatment center, with significant reductions in both overall survival (OS) and event-free survival (EFS) found for pts who were unemployed (OS, p<0.001; EFS, p=0.004) and who had a travel time of >75 minutes to a treatment center (OS, p=0.008; EFS, p=0.005). In addition, the presence of a complex karyotype also associated with reduced OS (p=0.02) and EFS (p=0.009). Multivariable Cox regression analysis for OS showed that reduced OS for pts with a travel time of >75 minutes (HR: 3.65, Cl: 1.53-8.69, p=0.003) was independent of the presence of a complex karyotype. Reduced EFS for pts who had a travel time of >75 minutes from a treatment center (HR: 3.16, Cl: 1.46-6.83, p=0.004) also proved to be independent of the presence of a complex karyotype. Furthermore, self-reported non-White race also independently associated with reduced EFS (HR: 3.33, Cl: 1.38-8.06, p=0.008). Conclusion: In addition to molecularly-based risk to define pt prognosis, our data provide support for the crucial contribution of neighborhood factors, especially treatment center distance, that independently affect pt survival. These potentially modifiable factors, that contrast with unmodifiable disease biology, may provide an important opportunity to improve survival with interventions that can overcome these survival modulators.

Introduction: Autologous Stem cell transplantation (ASCT) is the standard of care for patients (pts) newly diagnosed with Multiple Myeloma (MM). However, inequalities exist in ASCT utilization: older adults, Black pts, rural/community residing, and individuals with low socioeconomic status are among the least likely to receive a transplant for MM. Data report that older adults receive a ASCT only 9-18% of the time while Non-Hispanic Black pts receive a transplant half as often as Non-Hispanic White pts. Geographic location impacts the receipt of ASCT, and little is known about the Appalachian (central and southern sections of the Appalachian mountain region in eastern United States) population with MM, the majority of whom, live in rural areas. Differential access to transplant adversely impacts the outcomes of MM in these vulnerable populations. To increase transplant accessibility, we piloted a virtual ASCT consultative program to understand barriers and create accessibility at a center serving metropolitan, rural, and Appalachian communities, and to meet the needs of Black pt populations with MM. Methods: We conducted a single-institution prospective pilot study to identify barriers and increase access by implementing pt navigation and a virtual health consultation with MM transplant physicians. Participants were approached who were either age 65 years or older, self-identified as Black, or residing in a rural or Appalachian community. Rural-Urban Continuum Codes (RUCC) were used to classify residing counties as metropolitan (RUCC code 1-3) or nonmetropolitan (RUCC code 4-9). Appalachian counties were coded according to the 2020 Ohio Department of Development, Office of Research. Pts demographics and disease/treatment characteristics were collated. Pts or physician could elect to see in-person, in lieu of virtual consultation, at any point. Standardized Geriatric Assessment measures and Health Related Quality of Life (HRQoL) (PROMIS Global 10) were summarized using the median and range, or frequency and percentage depending on data type, and were compared between pts living in metro vs non-metro, and Appalachian area vs non-Appalachian area, and by race using the Mann-Whitney test or Fisher's exact test. Results: In total, 35 pts were consented, 33 were included in analysis (excluded, n=1 no access to internet, n=1 Smoldering MM). The median age was 68 (range 51-82), 23 (69%) were male and 5 (15%) pts were Black. Geo-demographically, pts were non-metropolitan n=14 (42%) and 5 (15%) were from an Appalachian area. High risk MM disease and stage were similar across groups (race, geography, rurality). In total, 24 pts were eligible for ASCT and 6 pts were ineligible. Pre-ASCT evaluation was done virtually for 18 pts and in-person for 17 pts. Seven pts declined ASCT, 2 collected and stored stem cells, and 15 pts proceeded to ASCT. Pts who underwent ASCT were younger (65 yo. vs. 71.5 yo., p=0.04), more likely to be employed (50% vs. 5.9%, p=0.01), had lower number of comorbidities (median 4 vs. 8, p=0.02) and less medications (median 9 vs. 11, p=0.04). Compared to non-metropolitan pts, more metropolitan pts received triplet regimen including bortezomib/lenalidomide/dexamethasone (VRD) (14 vs. 5, p=0.02), had higher Self-Reported KPS (90 vs. 75, p=0.007) while physician KPS and ASCT utilization were no different between the groups. Pts from Appalachian regions were more likely to be current/former smokers (p=0.025) and were less likely to receive quadruplet induction regimens (1 vs. 6, p=0.029), in this limited analysis. Among the entire cohort, Black pts with MM had younger, median age 59 (51-71), p=0.03, but there were no differences by gender, rurality, disease, treatment, ASCT receipt, performance status or comorbidities. There were no differences in HRQoL among pts by transplant status, geographical area, or race. Social support/activities, marital status, mental health, IADL, and religiousness or spirituality were also found to be similar among pt groups studied. Conclusion: In this pilot program, the use of pt navigation and virtual consultation are potential strategies to minimize pt travel and simplify healthcare access to MM transplant expertise. Ultimately, MM care is increasingly complex and providing alternative models, via virtual consult, to improve access to underserved and vulnerable populations is an unmet area of need in the MM community.

Objective We examined associations among changes in anthropometry, regional adiposity, and inflammatory markers in Black and White women participating in intentional weight loss. Methods A total of 104 women with BMI ≥ 25 kg/m ² self‐selected bariatric surgery ( n = 66) or a diet and exercise program ( n = 38). Anthropometric, dual‐energy x‐ray absorptiometry‐quantified regional adiposity, and inflammatory markers (C‐reactive protein [CRP], tumor necrosis factor α [TNF‐α], soluble TNF receptor I [sTNFRI], sTNFRII, interleukin [IL]‐6, and soluble IL‐1 receptor antagonist) were measured at baseline and 6 months. Results Weight, BMI, visceral adipose tissue, and regional (android and gynoid) adiposity declined in the bariatric surgery group. Among bariatric surgery participants, Black women experienced declines of lesser magnitude in terms of weight and BMI than White women, but changes in regional adiposity and visceral adipose tissue did not differ. In the bariatric surgery group, decreases in weight and BMI were associated with decreases in CRP and IL‐6 among White women, but not Black women. Decreases in weight, BMI, and android fat were associated with increases in TNF‐α, sTNFRI, and sTNFRII among Black women, but not White women. Conclusions Decreases in anthropometry and adiposity were observed among Black and White bariatric surgery participants; however, associations among changes in adiposity, anthropometry, and inflammation differed by race.

Background Despite the promise of mail-based human papillomavirus (HPV) self-collection programs for increasing cervical cancer screening, few have been evaluated in the United States. We report the results of a mail-based HPV self-collection program for underscreened women living in Appalachia. Methods We conducted a group randomized trial from 2021 to 2022 in the Appalachian regions of Kentucky, Ohio, Virginia, and West Virgnia. Participants were women of ages 30 to 64 years who were underscreened for cervical cancer and from a participating health system. Participants in the intervention group (n = 464) were mailed an HPV self-collection kit followed by telephone-based patient navigation (if needed), and participants in the usual care group (n = 338) were mailed a reminder letter to get a clinic-based cervical cancer screening test. Generalized linear mixed models compared cervical cancer screening between the study groups. Results Overall, 14.9% of participants in the intervention group and 5.0% of participants in the usual care group were screened for cervical cancer. The mail-based HPV self-collection intervention increased cervical cancer screening compared with the usual care group (OR, 3.30; 95% confidence interval, 1.90–5.72; P = 0.005). One or more high-risk HPV types were detected in 10.5% of the returned HPV self-collection kits. Among the participants in the intervention group whom patient navigators attempted to contact, 44.2% were successfully reached. Conclusions HPV self-collection increased cervical cancer screening, and future efforts are needed to determine how to optimize such programs, including the delivery of patient navigation services. Impact Mail-based HPV self-collection programs are a viable strategy for increasing cervical cancer screening among underscreened women living in Appalachia.

Several recent studies have investigated the validity of precautionary practices for lymphedema risk reduction after breast cancer treatment, such as avoidance of blood pressure measurements, skin puncture, blood draws, and use of prophylactic compression during air travel. Other studies have elucidated risk factors for breast cancer-related lymphedema, such as axillary lymph node dissection and skin infection (cellulitis). Combining the current evidence base with the consensus opinion of lymphatic experts assembled at the American Cancer Society/Lymphology Association of North America Summit in October 2023, updated evidence-based risk reduction recommendations are presented for those with or at risk of breast cancer-related lymphedema. Recommendation topics include prospective surveillance, patient education, individual risk factors, exercise, blood pressure, skin care and hygiene, skin puncture and blood draws, surgical procedures, prophylactic compression, air travel, and hot climate and sauna. These recommendations will help inform education and medical choices for individuals treated for breast cancer who are at risk of or diagnosed with breast cancer-related lymphedema. More high-quality evidence is required to allow the development of risk reduction recommendations for other cancer types such as gynecological, melanoma, and head and neck. It is recommended that clinicians and organizations serving people at risk of or with lymphedema align risk reduction guidelines with the evidence-based recommendations provided within this consensus document and companion manuscripts from the American Cancer Society/Lymphology Association of North America Lymphedema Summit: Forward Momentum: Future Steps in Lymphedema Management.

Extensive research supports an evidence-base for cancer treatment-related risk factors, including extent of lymph node dissection and use of radiotherapy, as contributing to secondary lymphedema. Additionally, comorbidities, such as higher body mass index, and vascular-related conditions are identified to further augment risk. While social determinants of health (SDOH) and socioeconomic factors are widely regarded as influencing an individual’s healthcare outcomes, including cancer risk and survival, these factors have not been explored as risk factors for developing secondary lymphedema. A rapid literature review explored the current evidence for SDOH as risk factors for lymphedema. Studies that were published over the last 10 years and that specifically analyzed social factors as variables associated with lymphedema were included. Studies that only characterized the social determinants of the study population were not included. Forty-nine studies were identified through a rapid literature review, and 13 studies that expressly analyzed social determinants as risk factors for secondary lymphedema were reviewed and extracted. All studies were conducted in patients with breast cancer-related lymphedema. Social risk factors included race, educational level, insurance type, and income level. These are consistent with the socioeconomic inequalities related to cancer survival. SDOH may influence the risk of developing cancer treatment-related health conditions like secondary lymphedema. Research trials studying cancer treatment-related conditions should collect consistent and robust data across social, behavioral, environmental, and economic domains and should analyze these variables to understand their contribution to study endpoints. Risk prediction modeling could be a future pathway to better incorporate social determinants, along with medical and co-morbidity data, to holistically understand lymphedema risk.

Background Multi-cancer early detection tests (MCEDs) have the potential to identify over 50 types of cancer from a blood sample, possibly transforming cancer screening paradigms. Studies on the safety and effectiveness of MCEDs are underway, but there is a paucity of research exploring public views on MCEDs. We sought to explore public perspectives and understanding on the use of MCEDs in patient care. Methods We conducted a cross-sectional, qualitative study using one-on-one, semi-structured interviews. Residents of the United States aged 45–70 years old were recruited through a survey panel and purposively sampled to maximize racial diversity. Interviews explored understanding of MCEDs and perspectives on their use. Interviews were analyzed using thematic analysis with deductive coding and semi-quantification. Results Among 27 participants, mean age was 62 years (range 48-70) and most (63%) were non-white. Most participants had completed at least one cancer screening (89%). Participants had a positive impression of MCEDs (85%) and found the concept easy to understand (88%). They were enthusiastic about the convenience of MCEDs (30%) and thought they would improve “cancer outcomes” by looking for multiple cancers (70%) and facilitating early detection (33%). Participants emphasized the need to balance these benefits against potential harms, including inaccuracy (96%), cost (92%), test-related anxiety (56%), and lack of evidence of effectiveness (22%). Participants favored that MCEDs be delivered in primary care (93%). Participants worried that the potential benefits of MCEDs might not be equitably distributed (44%). Conclusions Members of the US public in this study expressed an interest in using MCEDs but had concerns regarding cost, accuracy, and potential inequitable access to the tests. Findings suggest that MCEDs that are found to be safe and effective will be acceptable to patients as a part of primary care, and underscore public interest in improving this technology.